Proof of Service —
Criminal Record Clearing
CR-106, Page 1 of 2
Judicial Council of California, www.courts.ca.gov
New January 1, 2020, Optional Form
CR-106
Proof of Service —
Criminal Record Clearing
Clerk stamps date here when form is filed.
Fill in court name and street address:
Superior Court of California, County of
Fill in criminal case number and case name:
Case Number:
Case Name:
People of the State of California
v.
Service by mail
(a)
(b)
4
Before using this form, read Information on How to File a Proof of Service
in Criminal Record Clearing Requests (form CR-106-INFO).
1
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.
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
l
l
At the time I served the document or form listed below, I was at least 18
years old.
Instructions
My
Street
City State
Zip
2
I mailed or personally delivered the following document or form (fill in the name of the document you are
serving and complete or ):
3
5
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.
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
4
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.
business address is:home
A completed form should be filed with the court. Keep a copy of this form
for your records.
l
l
(c)
I mailed the envelope or envelopes on
With the U.S. Postal Service.
At an office or business mail drop where I know the mail is picked up every day and deposited
(1)
(2)
by depositing the envelope or envelopes (check one):
(date): from (city): (state):
This form is for proof of service by mail or personal delivery. For proof of
electronic service, use Proof of Electronic Service (form POS-050/EFS-050
).
with the U.S. Postal Service.
