Stanislaus — Proof of Service Criminal Record Clearing

Source: https://www.stanislaus.courts.ca.gov/system/files/cr-106.pdf

Proof of Service — CR-106 Clerk stamps date here when form is filed. Criminal Record Clearing Instructions l Before using this form, read Information on How to File a Proof of Service in Criminal Record Clearing Requests (form CR-106-INFO). l This form is only for providing proof that a document or form was served (delivered) in a case requesting that a court review a criminal record for dismissal, vacatur, resentencing, reduction, sealing, or other record clearing remedy. l The person who serves (delivers) a document or form in this case and who fills out this form must be at least 18 years old. Fill in court name and street address: l This form is for proof of service by mail or personal delivery. For proof of Superior Court of California, County of electronic service, use Proof of Electronic Service (form POS-050/EFS-050). l A completed form should be filed with the court. Keep a copy of this form for your records.

1 At the time I served the document or form listed below, I was at least 18 Fill in criminal case number and case name: years old. Case Number: 2 My home business address is: Case Name: People of the State of California v. Street City State Zip 3 I mailed or personally delivered the following document or form (fill in the name of the document you are serving and complete 4 or 5 ):

4 Service by mail (a) I put one copy of the document or form in an envelope addressed to each agency (and person, if applicable) listed below, sealed the envelope, and put first-class postage on the envelope. (b) The envelope or envelopes were addressed as follows: (1) Name of agency served (and person, if applicable): Address on envelope: Street City State Zip (2) Name of agency served (and person, if applicable): Address on envelope: Street City State Zip Check here if you mailed copies of the document or form to more people or agencies. Attach a separate page listing the names and addresses on each additional envelope you mailed. Write “CR-106, Item 4” on the top of the page. (c) I mailed the envelope or envelopes on (date): from (city): (state): by depositing the envelope or envelopes (check one): (1) With the U.S. Postal Service. (2) At an office or business mail drop where I know the mail is picked up every day and deposited with the U.S. Postal Service. Judicial Council of California, www.courts.ca.gov Proof of Service — CR-106, Page 1 of 2 New January 1, 2020, Optional Form Criminal Record Clearing

Case Number:

5 Service by Personal Delivery

I personally gave one copy of the document or form to each of the following:

(a) Name of person and agency served:
(1) Address where you gave the document or form to this person:

Street City State Zip

(2) Date when you gave the document or form to this person:
(3) Time when you gave the document or form to this person:
(b) Name of person and agency served:
(1) Address where you gave the document or form to this person:

Street City State Zip

(2) Date when you gave the document or form to this person:

(3) Time when you gave the document or form to this person:
Check here if you gave copies of the document or form to more people. Attach a separate page
listing the names of each of these people, the address where you gave each of them the document
or form, and the date and time you gave them the document or form. Write “CR-106, Item 5” on
the top of the page.

6 I declare under penalty of perjury under California state law that the information above is true and correct.

Date:

Type or print server’s name Server signs here after serving

New January 1, 2020 Proof of Service — CR-106, Page 2 of 2 Criminal Record Clearing For your protection and privacy, please press the Clear This Form button after you have printed the form. Print this form Save this form Clear this form