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Proof Of Service By Mail-CLETS Form. This is a California form and can be use in Elder Or Dependent Adult Abuse Judicial Council.
Tags: Proof Of Service By Mail-CLETS, EA-141, California Judicial Council, Elder Or Dependent Adult Abuse
EA-141
Proof of Service by Mail
1
Name of person asking for protection:
2
Clerk stamps date here when form is filed.
Your name:
3
Notice to Server
Fill in court name and street address:
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 .
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:_____________
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
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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