Request For Sheriff To Serve And Sheriffs Fee Statement {FM-1041}

ATTACHMENT FM-1041 Protected Person's Name: Case Number: CONFIDENTIAL--DO NOT FILE IN COURT FILE 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 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 American LegalNet, Inc. www.FormsWorkFlow.com