ATTORNEY OR PARTY WITHOUT ATTORNEY (Name & Address): FOR COURT USE ONLY Telephone No.: E-Mail Address (Optional): ATTORNEY FOR (Name): Fax No. (Optional): Bar No: SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE CENTRAL JUSTICE CENTER 700 CIVIC CENTER DRIVE WEST POST OFFICE BOX 22024 SANTA ANA, CA 92702-2024 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: M- 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 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). Page 1 of 2 PROOF OF SERVICE PETITION FOR REHABILITATION AND PARDON Optional Use Form: L-0801 [Rev. March 24, 2011] Penal Code, §§ 4852.01 and 4852.06 American LegalNet, Inc. www.FormsWorkFlow.com Name: Case Number: M- 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: ORANGE COUNTY DISTRICT ATTORNEY 401 CIVIC CENTER DRIVE WEST SANTA ANA, CA 92701 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) Page 2 of 2 PROOF OF SERVICE PETITION FOR REHABILITATION AND PARDON Optional Use Form: L-0801 [Rev. March 24, 2011] Penal Code, §§ 4852.01 and 4852.06 American LegalNet, Inc. www.FormsWorkFlow.com