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Here is the text we could read:

CR-416

Proof of Service—Sex Offender
Registration Termination
(Pen. Code, § 290.5)

Clerk stamps date here when form is filed.

Instructions
•

This form is for providing proof that a copy of a filed Petition to
Terminate Sex Offender Registration (form CR-415) and proof of current
registration was served (delivered) to the required law enforcement
agencies and district attorney’s offices. Read Information on Filing a
Petition to Terminate Sex Offender Registration (form CR-415-INFO) for
more information.
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 for proof of service by mail or personal delivery. For proof of
electronic service, read and follow rule 2.251 of the California Rules of
Court, and use Proof of Electronic Service (form POS-050/EFS-050).
File a completed form with the court. Keep a copy of this form for your
records.

1 At the time I served the Petition to Terminate Sex Offender Registration
(form CR-415) and proof of current registration, I was at least 18 years
old.

Fill in case number:

Case Number:

2 My name is:

My mailing address is:

Fill in court name and street address:

Superior Court of California, County of

Street
I served copies of the Petition to Terminate Sex Offender Registration and proof of current registration filed (check
one):

State Zip

City

for myself

on behalf of (name of petitioner):

I mailed or personally delivered a filed-stamped copy of Petition to Terminate Sex Offender Registration (form
CR-415) and proof of current registration to the agencies listed below:
a.

•

City

State Zip

Mailed the documents to the agency at the address above in a sealed envelope from

by depositing the envelope with the U.S. Postal Service
at (time):

Registering law enforcement agency
Name of agency:

Address:

Street
Date of service:
Method of service (check one):

(city, state):

Delivered in person to (name):

at the address above.
District attorney (county of registration):
County of:
Address:

Street
Date of service:

Method of service (check one):

(city, state):

Delivered in person to (name):

at the address above.

City

State Zip

Mailed the documents to the district attorney’s office at the address above in a sealed envelope from

by depositing the envelope with the U.S. Postal Service or
at (time):

Judicial Council of California,
New July 1, 2021, Optional Form
Pen. Code, § 290.5

Proof of Service—Sex Offender
Registration Termination (Pen. Code, § 290.5)

CR-416, Page 1 of 2

Case Number:

City

State Zip

Law enforcement agency (county of conviction, if different than county of registration)

Name of agency:
Address:

Street
Date of service:
Method of service (check one):

(city, state):

Delivered in person to (name):

at the address above.

County of:
Address:

Street

Date of service:
Method of service (check one):

Mailed the documents to the agency at the address above in a sealed envelope from

by depositing the envelope with the U.S. Postal Service
at (time):

District attorney (county of conviction, if different than county of registration)

City

State Zip

Mailed the documents to the district attorney's office at the address above in a sealed envelope from

(city, state):

by depositing the envelope with the U.S. Postal Service

Delivered in person to

(name):

at the address above.

at (time):

Check here if you served copies of the petition and proof of current registration to additional law
enforcement agencies and district attorney's offices. Attach a separate page listing the names,
addresses, date of service, and method of service of each additional copy you served. Write
“CR-416, Item 4” on the top of the page.

I declare under penalty of perjury under California state law that the information above is true and correct.

Date:

Type or print server’s name

Server signs here after serving

New July 1, 2021

Proof of Service—Sex Offender
Registration Termination (Pen. Code, § 290.5)

CR-416, Page 2 of 2

Proof of Service—Sex Offender Registration Termination (Pen. Code, § 290.5)

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the California state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from selfhelp.courts.ca.gov (2023-03)
Page(s): 2
Fields(s): 60
Average fields per page: 30
Reading Level: Grade 6
LIST Grouping(s): Unknown

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

r_page_right_caption_court_info was CR-416[0].Page1[0].RightCaption[0].CourtInfo[0].CourtInfo[0] (0.55 conf)
r_page_right_n_case_number was CR-416[0].Page1[0].RightCaption[0].CN[0].CaseNumber[0] (0.38 conf)
c_r_page_list_item_fill_text__1 was CR-416[0].Page1[0].List2[0].item2[0].FillText59[0] (0.37 conf)
page_item_appellant_lawyer_address was CR-416[0].Page1[0].List2[0].item2[0].AppellantLawyerMailingAddress[0] (0.42 conf)
page_list_item_lawyer_city was CR-416[0].Page1[0].List2[0].item2[0].AppellantLawyerMailingCity[0] (0.42 conf)
page_list_item_lawyer_state was CR-416[0].Page1[0].List2[0].item2[0].AppellantLawyerMailingState[0] (0.42 conf)
page_list_item_appellant_lawyer was CR-416[0].Page1[0].List2[0].item2[0].AppellantLawyerMailingZip[0] (0.42 conf)
c_page_list_item_check_box_b__1 was CR-416[0].Page1[0].List3[0].item3[0].CheckBox28b[0] (0.42 conf)
c_page_list_item_check_box_b__2 was CR-416[0].Page1[0].List3[0].item3[0].CheckBox28b[1] (0.42 conf)
c_r_page_list_item_fill_text__2 was CR-416[0].Page1[0].List3[0].item3[0].FillText7[0] (0.37 conf)
c_r_page_list_lia_fill_text__1 was CR-416[0].Page1[0].List4[0].Lia[0].FillText20[0] (0.39 conf)
c_r_page_list_lia_srv_mailing_address was CR-416[0].Page1[0].List4[0].Lia[0].SrvMailingAddress2[0] (0.41 conf)
c_r_page_list_lia_city was CR-416[0].Page1[0].List4[0].Lia[0].SrvMailingCity2[0] (0.41 conf)
c_r_page_list_lia_srv_mailing_state was CR-416[0].Page1[0].List4[0].Lia[0].SrvMailingState2[0] (0.41 conf)
c_r_page_list_lia_srv was CR-416[0].Page1[0].List4[0].Lia[0].SrvMailingZip2[0] (0.41 conf)
c_r_page_list_lia_fill_text__2 was CR-416[0].Page1[0].List4[0].Lia[0].FillText21[0] (0.39 conf)
c_r_page_list_lia_mailed__1 was CR-416[0].Page1[0].List4[0].Lia[0].mailed[0] (0.34 conf)
c_r_page_list_lia_fill_text__3 was CR-416[0].Page1[0].List4[0].Lia[0].FillText22[0] (0.39 conf)
c_r_page_list_lia_mailed__2 was CR-416[0].Page1[0].List4[0].Lia[0].mailed[1] (0.34 conf)
c_r_page_list_lia_fill_text__4 was CR-416[0].Page1[0].List4[0].Lia[0].FillText23[0] (0.39 conf)
c_r_page_list_lia_fill_text__5 was CR-416[0].Page1[0].List4[0].Lia[0].FillText24[0] (0.39 conf)
c_r_page_list_lib_fill_text__1 was CR-416[0].Page1[0].List4[0].Lib[0].FillText26[0] (0.39 conf)
c_r_page_list_lib_address was CR-416[0].Page1[0].List4[0].Lib[0].SrvMailingAddress3[0] (0.41 conf)
c_r_page_list_lib_city was CR-416[0].Page1[0].List4[0].Lib[0].SrvMailingCity3[0] (0.41 conf)
c_r_page_list_lib_state was CR-416[0].Page1[0].List4[0].Lib[0].SrvMailingState3[0] (0.41 conf)
c_r_page_list_lib_zip was CR-416[0].Page1[0].List4[0].Lib[0].SrvMailingZip3[0] (0.41 conf)
c_r_page_list_lib_fill_text__2 was CR-416[0].Page1[0].List4[0].Lib[0].FillText25[0] (0.39 conf)
c_r_page_list_lib_mailed__1 was CR-416[0].Page1[0].List4[0].Lib[0].Mailed3[0] (0.37 conf)
c_r_page_list_lib_fill_text__3 was CR-416[0].Page1[0].List4[0].Lib[0].FillText30[0] (0.39 conf)
c_r_page_list_lib_mailed__2 was CR-416[0].Page1[0].List4[0].Lib[0].Mailed3[1] (0.37 conf)
c_r_page_list_lib_fill_text__4 was CR-416[0].Page1[0].List4[0].Lib[0].FillText32[0] (0.39 conf)
c_r_page_list_lib_fill_text__5 was CR-416[0].Page1[0].List4[0].Lib[0].FillText33[0] (0.39 conf)
c_r_page_caption_case_number was CR-416[0].Page2[0].PxCaption[0].CaseNumber[0] (0.37 conf)
c_r_page_list_lic_ch was CR-416[0].Page2[0].List4[0].Lic[0].Ch1[0] (0.37 conf)
c_r_page_list_lic_fill_text__1 was CR-416[0].Page2[0].List4[0].Lic[0].FillText36[0] (0.39 conf)
c_r_page_list_lic_srv_mailing_address was CR-416[0].Page2[0].List4[0].Lic[0].SrvMailingAddress4[0] (0.41 conf)
c_r_page_list_lic_srv_mailing_city was CR-416[0].Page2[0].List4[0].Lic[0].SrvMailingCity4[0] (0.41 conf)
c_r_page_list_lic_srv_mailing_state was CR-416[0].Page2[0].List4[0].Lic[0].SrvMailingState4[0] (0.41 conf)
c_r_page_list_lic_srv_mailing_zip was CR-416[0].Page2[0].List4[0].Lic[0].SrvMailingZip4[0] (0.41 conf)
c_r_page_list_lic_fill_text__2 was CR-416[0].Page2[0].List4[0].Lic[0].FillText40[0] (0.39 conf)
c_r_page_list_lic_check_box__1 was CR-416[0].Page2[0].List4[0].Lic[0].CheckBox4c[0] (0.42 conf)
c_r_page_list_lic_fill_text__3 was CR-416[0].Page2[0].List4[0].Lic[0].FillText59[0] (0.39 conf)
c_r_page_list_lic_check_box__2 was CR-416[0].Page2[0].List4[0].Lic[0].CheckBox4c[1] (0.42 conf)
c_r_page_list_lic_fill_text__4 was CR-416[0].Page2[0].List4[0].Lic[0].FillText41[0] (0.39 conf)
c_r_page_list_lic_fill_text__5 was CR-416[0].Page2[0].List4[0].Lic[0].FillText42[0] (0.39 conf)
c_r_page_list_lid_ch was CR-416[0].Page2[0].List4[0].Lid[0].Ch2[0] (0.37 conf)
c_r_page_list_lid_fill_text__1 was CR-416[0].Page2[0].List4[0].Lid[0].FillText44[0] (0.39 conf)
c_r_page_list_lid_srv_mailing_address was CR-416[0].Page2[0].List4[0].Lid[0].SrvMailingAddress5[0] (0.41 conf)
c_r_page_list_lid_srv_mailing_city was CR-416[0].Page2[0].List4[0].Lid[0].SrvMailingCity5[0] (0.41 conf)
c_r_page_list_lid_srv_mailing_state was CR-416[0].Page2[0].List4[0].Lid[0].SrvMailingState5[0] (0.41 conf)
c_r_page_list_lid_srv_mailing_zip was CR-416[0].Page2[0].List4[0].Lid[0].SrvMailingZip5[0] (0.41 conf)
c_r_page_list_lid_fill_text__2 was CR-416[0].Page2[0].List4[0].Lid[0].FillText45[0] (0.39 conf)
c_r_page_list_lid_check_box__1 was CR-416[0].Page2[0].List4[0].Lid[0].CheckBox33[0] (0.42 conf)
c_r_page_list_lid_check_box__2 was CR-416[0].Page2[0].List4[0].Lid[0].CheckBox4d[0] (0.42 conf)
c_r_page_list_lid_fill_text__3 was CR-416[0].Page2[0].List4[0].Lid[0].FillText60[0] (0.39 conf)
c_r_page_list_lid_check_box__3 was CR-416[0].Page2[0].List4[0].Lid[0].CheckBox4d[1] (0.42 conf)
c_r_page_list_lid_fill_text__4 was CR-416[0].Page2[0].List4[0].Lid[0].FillText62[0] (0.39 conf)
c_r_page_list_lid_fill_text__5 was CR-416[0].Page2[0].List4[0].Lid[0].FillText63[0] (0.39 conf)
c_r_page_sign_sig_date was CR-416[0].Page2[0].Sign[0].SigDate[0] (0.31 conf)
c_r_page_sign_sig_name was CR-416[0].Page2[0].Sign[0].SigName[0] (0.31 conf)

We've done our best to group similar variables togther to avoid overwhelming the user.

Suggested Screen 0:

r_page_right_caption_court_info

Suggested Screen 1:

r_page_right_n_case_number
c_r_page_caption_case_number

Suggested Screen 2:

page_item_appellant_lawyer_address
page_list_item_lawyer_city
page_list_item_lawyer_state
page_list_item_appellant_lawyer

Suggested Screen 3:

c_page_list_item_check_box_b__1
c_page_list_item_check_box_b__2

Suggested Screen 4:

c_r_page_list_item_fill_text__1
c_r_page_list_item_fill_text__2
c_r_page_list_lia_fill_text__1
c_r_page_list_lia_fill_text__2
c_r_page_list_lia_mailed__1
c_r_page_list_lia_fill_text__3
c_r_page_list_lia_mailed__2
c_r_page_list_lia_fill_text__4
c_r_page_list_lia_fill_text__5

Suggested Screen 5:

c_r_page_list_lia_city
c_r_page_list_lib_address
c_r_page_list_lib_city
c_r_page_list_lib_state
c_r_page_list_lib_zip

Suggested Screen 6:

c_r_page_list_lib_fill_text__1
c_r_page_list_lib_fill_text__2
c_r_page_list_lib_mailed__1
c_r_page_list_lib_fill_text__3
c_r_page_list_lib_mailed__2
c_r_page_list_lib_fill_text__4
c_r_page_list_lib_fill_text__5

Suggested Screen 7:

c_r_page_list_lia_srv_mailing_address
c_r_page_list_lia_srv_mailing_state
c_r_page_list_lia_srv
c_r_page_list_lic_ch
c_r_page_list_lic_srv_mailing_address
c_r_page_list_lic_srv_mailing_city
c_r_page_list_lic_srv_mailing_state
c_r_page_list_lic_srv_mailing_zip

Suggested Screen 8:

c_r_page_list_lic_fill_text__1
c_r_page_list_lic_fill_text__2
c_r_page_list_lic_fill_text__3
c_r_page_list_lic_fill_text__4
c_r_page_list_lic_fill_text__5

Suggested Screen 9:

c_r_page_list_lid_ch
c_r_page_list_lid_fill_text__1
c_r_page_list_lid_fill_text__2
c_r_page_list_lid_fill_text__3
c_r_page_list_lid_fill_text__4
c_r_page_list_lid_fill_text__5

Suggested Screen 10:

c_r_page_list_lid_srv_mailing_address
c_r_page_list_lid_srv_mailing_city
c_r_page_list_lid_srv_mailing_state
c_r_page_list_lid_srv_mailing_zip

Suggested Screen 11:

c_r_page_list_lic_check_box__1
c_r_page_list_lic_check_box__2
c_r_page_list_lid_check_box__1
c_r_page_list_lid_check_box__2
c_r_page_list_lid_check_box__3

Suggested Screen 12:

c_r_page_sign_sig_date
c_r_page_sign_sig_name

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Proof of Service—Sex Offender Registration Termination (Pen. Code, § 290.5)

About This Form:

Identified Data Fields:

Create an Interactive Version of this Form:

The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02