Page 1 of 2 PROOF OF SERVICE PETITION FOR REHABILITATION AND PARDON Optional Use Penal Code, 247247 4852.01 and 4852.06 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name & Address): Fax No. (Optional): Telephone No.:E-Mail Address (Optional): ATTORNEY FOR (Name): Bar No: FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF IN THE MATTER OF THE APPLICATION OF Petitioner's full name - First, Middle, Last PROOF OF SERVICE Petition for Certificate of Rehabilitation and Pardon CASE NUMBER: TO BE COMPLETED BY THE PERSON SERVING. THE PERSON SERVING MUST NOT BE THE PETITIONER.(This is a two-page form - Complete both pages)Check all applicable boxes: I am over the age of 18 years and am not a party to the within action. My Name My Address I served a copy of the Notice of Filing of Petition for Certificate of Rehabilitation and Pardon, the Petition for Certificate of Rehabilitation and Pardon and any attachments thereto on the: GOVERNOR OF THE STATE OF CALIFORNIA DEPARTMENT OF LEGAL AFFAIRS STATE CAPITOL BUILDING 1303 10TH ST SACRAMENTO CA 95814-4910 By Personal Service: On (date), I personally delivered a copy of the Notice, Petition and attachments to the address above. The name of the person who received the copies is OR By Mail:On (date), I personally mailed a copy of the Notice, Petition and attachments to the address above, by placing it in a sealed envelope with postage thereon fully prepaid into the United States mail at (place of mailing). My Address American LegalNet, Inc. www.FormsWorkFlow.com Name: Case Number: Page 2 of 2 PROOF OF SERVICE PETITION FOR REHABILITATION AND PARDON Optional Use Penal Code, 247247 4852.01 and 4852.06 I served a copy of the Notice of Filing of Petition for Certificate of Rehabilitation and Pardon, the Petition for Certificate of Rehabilitation and Pardon and any attachments thereto on the: COUNTY DISTRICT ATTORNEY By Personal Service:On (date), I personally delivered a copy of the Notice, Petition and attachments to the address above. The name of the person who received the copies is . OR By Mail:On (date), I personally mailed a copy of the Notice, Petition and attachments to the address above, by placing it in a sealed envelope with postage thereon fully prepaid into the United States mail at (place of mailing). I served a copy of the Notice of Filing of Petition for Certificate of Rehabilitation and Pardon, the Petition for Certificate of Rehabilitation and Pardon and any attachments thereto on the: COUNTY DISTRICT ATTORNEY (ADDRESS) (ADDRESS) By Personal Service:On (date), I personally delivered a copy of the Notice, Petition and attachments to the address above. The name of the person who received the copies is . OR By Mail:On (date), I personally mailed a copy of the Notice, Petition and attachments to the address above, by placing it in a sealed envelope with postage thereon fully prepaid into the United States mail at (place of mailing). I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: (TYPE OR PRINT NAME OF PERSON WHO SERVED THE PAPERS)(SIGNATURE OF PERSON SERVING) American LegalNet, Inc. www.FormsWorkFlow.com