SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: FOR COURT USE ONLY PEOPLE OF THE STATE OF CALIFORNIA vs. DEFENDANT: CRIMINAL CASE NUMBER: PROOF OF SERVICE BY MAIL FAMILY/ CIVIL CASE NUMBER: Protected Persons' Name: Restrained Persons' Name: Notice to Server ­ You must: Be 18 or over. Not be listed as a Protected Person or Party on the Civil restraining order or Criminal Protective Order. Mail a copy of the forms checked below to the people or organizations checked below. I placed a copy of the forms checked below in the mail in a sealed envelope: Request and Order for Hearing on Protective Order Modification (form #CR-6003) Protective Order in a Criminal Proceeding (form #CR-160) and mailed them as follows: a. Date mailed: b. Mailed from (City): (State): c. Mailed to: (Check everyone who was involved in the original case. Put the name and address): Defendant (Restrained Person): Protected Person: Deputy District Attorney: Defense Attorney: Adult Probation: Other: I am not a registered process server. I am over the age of 18. I declare under penalty of perjury under the laws of the state of California that the information on this form is true and correct. Date: Type or Printer Server's Name Here Server to Sign Here CR-6004 REV. 4/07 PROOF OF SERVICE BY MAIL (CRIMINAL) Page 1 of 1 American LegalNet, Inc. www.FormsWorkflow.com