Free EA-141 - California

EA-141
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Proof of Service by Mail

Clerk stamps date here when form is filed.

Name of person asking for protection: Your name:

Notice to Server
The server must: · Be over 18 years of age. · Be a resident or employed in the county where the mailing took place. · Not be listed on the restraining order. · Mail a copy of all documents checked in 4 to the person in 1 . Complete and sign this form and give it to the person in 2 .

Fill in court name and street address:

Superior Court of California, County of

Fill in case number:

Case Number:

PROOF OF SERVICE BY MAIL
4 I am over 18 years of age and am a resident or employed in the county where the mailing took place. I mailed the person in 1 a copy of all documents checked below: a. b. 5 Form EA-110, Response to Request for Orders to Stop Elder or Dependent Adult Abuse (completed) Other (specify):

I placed copies of the documents checked above in a sealed envelope and mailed them as described below: a. Mailed from (City):_________________________________________ (State): ___________________ b. On (Date):________________________________________________ c. To this Address:______________________________________________________________________ City: ________________________________________State:_________________ Zip:_____________

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Server's Information
Name:_______________________________________________________________________________ Address:______________________________________________________________________________ City: ______________________________________________State:_______________ Zip:___________ Telephone:__________________________ (If you are a registered process server): County of registration: _______________________________ Registration number:__________________

I declare under penalty of perjury under the laws of the State of California that the information above is true and correct.
Date:_________________________

Type or print server's name
Judicial Council of California, www.courtinfo.ca.gov Rev. January 1, 2007, Optional Form Welfare & Institutions Code, § 15657.03

Server signs here

Proof of Service by Mail--CLETS
(Elder and Dependent Adult Abuse Prevention)

EA-141, Page 1 of 1
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