WV 250 Proof Of Service Response By Mail & WV250

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WV-250

Proof of Service of
Response by Mail

Clerk stamps date here when form is filed.

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your form, please press the
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end of the form when finished.

1 Petitioner (Employer)
Name:
2 Employee in Need of Protection
Name:
3 Respondent (Person From Whom Protection Is Sought)
Name:

Fill in court name and street address:

Superior Court of California, County of

4 Notice to Server
The server must:
• Be 18 years of age or older.
• Be a resident of or employed in the
county where the mailing took place.
• Not be the respondent.
• Mail a copy of all documents
checked in 5 below to the petitioner or
the petitioner’s lawyer.
Complete
and sign this form and give it
•
to the respondent.

Fill in case number:

Case Number:

PROOF OF SERVICE BY MAIL
5 I am 18 years of age or older and not a party to this proceeding. I am live or am employed in the county where
the mailing took place. I mailed the petitioner or the petitioner’s lawyer a copy of:
a. Form WV-120, Response to Petition for Workplace Violence Restraining Order (completed)
b.
Other (specify):
6 I placed copies of the documents listed above in a sealed envelope and mailed them as described below:
a. Mailed to (name):
b. To this address:
City:
c. On (date):

State:

Zip:

Mailed from: City:

State:

7 Server’s Information
Telephone:

Name:
Address:
City:

Zip:

State:

(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
Revised January 1, 2012, Optional Form
Code of Civil Procedure, § 527.8

Server to sign here

Proof of Service of Response by Mail

WV-250, Page 1 of 1

(Workplace Violence Prevention)

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