Notice to Server
County of registration:
City: State: Zip:
I (the server) am 18 years of age or over and live in or am employed
in the county where the mailing took place. I mailed a copy of all
documents checked below to the person in :
I placed copies of the documents checked above in a sealed envelope and mailed them as described below:
If you are a registered process server:
Be 18 years of age or over.
Mail a copy of all documents checked in
to the person in .
Not be listed in items , or of form DV-100, Request for
Domestic Violence Restraining Order.
Clerk stamps date here when form is filed.
Fill in court name and street address:
Superior Court of California, County of
Fill in case number:
DV-112, Waiver of Hearing on Denied Request for Temporary
DV-120, Response to Request for Domestic Violence Restraining Order
FL-150, Income and Expense Declaration
DV-130, Restraining Order After Hearing (Order of Protection)
FL-155, Simplified Financial Statement
Proof of Service by Mail
Judicial Council of California, www.courts.ca.gov
Revised January 1, 2020, Optional Form
Family Code, §§ 6324, 6340-6344
Proof of Service by Mail (CLETS)
(Domestic Violence Prevention)
DV-250, Page 1 of 1
Name of Person Asking for Protection:
Name of Person to Be Restrained:
The server must:
To this address:
Name of person served:
Mailed on (date):
Mailed from (city):
Server to sign here
I declare under penalty of perjury under the laws of the State of California that the information above is true and
Type or print server's name
For your protection and privacy, please press the Clear
This Form button after you have printed the form.