CH 250 Proof Of Service Response By Mail Ch250

User Manual: CH-250

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CH-250
1

Proof of Service of Response by
Mail

To keep other people from
seeing what you entered on
your form, please press the
Clear This Form button at the
end of the form when finished.

Person Seeking Protection
Name:

2

Clerk stamps date here when form is filed.

Person From Whom Protection Is Sought
Your Name:

3

Notice to Server
The server must:
• Be 18 years of age or older.
• Live or be employed in the county
where the mailing took place.
• Not be listed in items 1 or 3 of Form
CH-100.
• Mail a copy of all documents
checked in 4 to the person in 1 .
• Complete and sign this form and give
it to the person in 2 .

Fill in court name and street address:

Superior Court of California, County of

Fill in case number:

Case Number:

PROOF OF SERVICE BY MAIL
4

I am 18 years of age or older and not a party to this proceeding. I live or am employed in the county where the
mailing took place. I mailed the person in 1 a copy of all documents checked below:
a. Form CH-120, Response to Request for Civil Harassment Restraining Orders
b.
Other (specify):

5

I placed copies of the documents checked above in a sealed envelope and mailed them as described below:
a. Mailed to (name):
b. To this address:
City:
c. On (date):

6

Zip:

State:
Mailed from: City:

State:

Server’s Information
Name:
Address:
City:

Zip:

State:

Telephone:
(If you are a registered process server):
Registration number:

County of registration:

I declare under penalty of perjury under the laws of the State of California that the information above is true and
correct.
Date:


Type or print server’s name
Judicial Council of California, www.courts.ca.gov
Rev. January 1, 2012, Optional Form
Code of Civil Procedure, § 527.6

Server to sign here

Proof of Service of Response by Mail

CH-250, Page 1 of 1

(Civil Harassment Prevention)

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button after you have printed the form.

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