Form L- None
Revised: 03/10/2016
Optional Form
Penal Code 1203.43
Page 2 of 2
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, Address, Telephone No, Email)
ATTORNEY FOR (Name) Bar No.
FOR COURT USE ONLY
SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE
JUSTICE CENTER:
Central - 700 Civic Center Dr. West, Santa Ana, CA 92701
Harbor-Newport Beach - 4601 Jamboree Rd., Newport Beach, CA 92660
North - 1275 N. Berkeley Ave., P. O. Box 5000, Fullerton, CA 92838-0500
West - 8141 13
th
Street, Westminster, CA 92683
PEOPLE OF THE STATE OF CALIFORNIA
VS.
Defendant:
PERSONAL SERVICE SERVICE BY MAIL
Case Number:
This is a proof of service of a Petition for Dismissal under Penal Code 1203.43.
DIRECTIONS: A copy of this petition must be served upon the District Attorney or City Attorney who prosecuted your
case. Mail the front and back of each page of this document to the District Attorney or City Attorney who prosecuted the
case. When the petition has been served, the original may then be filed with the court.
1.
Person serving. I am over the age of 18 and not a party to this action.
Name:
Address:
Tel
ephone:
2.
I served a copy of the Petition for Dismissal under Penal Code 1203.43 as follows (check either a or b below):
a.
Personal Service: I personally delivered the Petition for Dismissal under Penal Code 1203.43 to
the person at the address listed below:
(1)
Name of person served:
(2)
Address where served:
(3)
Date served:
(4)
Time served:
b.
Service by Mail: I deposited
the Petition for Dismissal under Penal Code 1203.43 in the United States
mai
l, in a sealed envelope with postage fully prepaid. The envelope was addressed as follows:
(1)
Name of person served:
(2)
Address:
(3)
Date of Mailing:
(4)
Place of Mailing (city and state):
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(Type or print name) (Signature of Declarant)