Form Ea-141 - Proof Of Service By Mail
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1Clerk stamps date here when form is filed.
EA-141
Proof of Service by Mail
To keep other people from
1
Name of person asking for protection:
seeing what you entered on
your form, please press the
Clear This Form button at the
2
Your name:
end of the form when finished.
3
Notice to Server
Fill in court name and street address:
The server must:
Superior Court of California, County of
•
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
to the person in
4
Fill in case number:
. Complete and sign this form
Case Number:
1
and give it to the person in
.
2
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
a copy of all documents checked below:
1
a.
Form EA-110, Response to Request for Orders to Stop Elder or Dependent Adult Abuse (completed)
b.
Other (specify):
5
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:_____________
6
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
Server signs here
Proof of Service by Mail—CLETS
Judicial Council of California,
EA-141,
Page 1 of 1
Rev. January 1, 2007, Optional Form
(Elder and Dependent Adult Abuse Prevention)
Welfare & Institutions Code, § 15657.03
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