Fillable Request for Sheriff to Serve and Sheriffs Fee

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Request for Sheriff to Serve and Sheriffs Fee

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ATTACHMENT FM-1041
Protected Person’s Name: Case Number:
CONFIDENTIAL--DO NOT FILE IN COURT FILE
FM-1041 REV 1/25/08
(non-substantive change 3/3/11)
REQUEST FOR SHERIFF TO SERVE AND
SHERIFF’S FEE STATEMENT
Page 1 of 1
Request for Sheriff to Serve and Sheriff’s Fee Statement
I WANT THE SHERIFF TO SERVE THE ATTACHED LEGAL FORMS WITHIN SANTA CLARA
COUNTY AT NO COST TO ME.
To the Sheriff: Serve the attached legal forms on the Restrained Party in this case. Send a copy of
the Proof of Service or any other documents to:
the Protected Party’s Attorney
the Protected Party at the address listed below:
Today’s Date:
Sign Your Name Here
Protected Person/Protected Person’s Attorney –
Do not fill out anything below this line
INFORMATION BELOW IS TO BE COMPLETED BY SHERIFF’S OFFICE PERSONNEL ONLY
Service of the order was made or attempted on (date):
Fee for Service: $
Type or Print Name of Sheriff’s Office Representative Signature of Law Enforcement Representative
Title of Agency
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Request for Sheriff to Serve and Sheriffs Fee

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Completed 28 June 2021

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