Mendocino — MCR-105

Source: https://www.mendocino.courts.ca.gov/system/files/forms-and-filings/mcr-105.pdf

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number and Address) For Court Use Only

TELEPHONE NO.: FAX NO. (Optional):

E-MAIL ADDRESS (Optional):

ATTORNEY FOR (Name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF MENDOCINO

UKIAH Courthouse TEN MILE Branch Court
100 North State Street 700 South Franklin Street
Ukiah, CA 95482 Fort Bragg, CA 95437

PLAINTIFF: PEOPLE OF THE STATE OF CALIFORNIA CASE NUMBER:

DEFENDANT: HEARING DATE:

TIME:

PROOF OF SERVICE DEPARTMENT:

1. I am over 18 years of age.

2. I served the following documents (specify): “Request to Calendar Case”

3. I personally delivered a true copy thereof and caused such to be delivered by hand to
   the District Attorney’s Office at the address, date, and time stated:

   a. Address: Courthouse Room # G-10, Ukiah, CA 95482
   Courthouse Room # 144, Fort Bragg, CA 95437
   b. Date:
   c. Time:

4. I placed a true copy thereof enclosed in a sealed envelope with postage thereon fully

   prepaid in the United States mail addressed to the Mendocino County District Attorney at:

   PO Box 1000, Ukiah, CA 95482 Ten Mile Justice Center, 700 South Franklin Street, Room #148, Fort Bragg, CA 95437

5. My name, address, telephone number:

   a. Name: b. Address: c. Telephone number:

6. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Date:

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(TYPE/PRINT NAME OF PERSON WHO SERVED THE PAPERS) (SIGNATURE OF PERSON WHO SERVED THE PAPERS)

MCR-105 (rev 0425)