Notice to Server
b.
d.
County of registration:
City: State: Zip:
Telephone:
Name:
Address:
Server’s Information
6
7
a.
c.
b.
c.
a.
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 :
5
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:
Case Number:
DV-112, Waiver of Hearing on Denied Request for Temporary
Restraining Order
DV-120, Response to Request for Domestic Violence Restraining Order
FL-150, Income and Expense Declaration
f.
Other
e.
DV-130, Restraining Order After Hearing (Order of Protection)
d.
FL-155, Simplified Financial Statement
DV-250
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
1
2
3
4
Name of Person Asking for Protection:
Name of Person to Be Restrained:
2
1
3
4
5
5
(specify):
The server must:
•
•
•
To this address:
Name of person served:
Mailed on (date):
Mailed from (city):
Zip:State:City:
(state):
Registration number:
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
correct.
Date:
Type or print server's name
For your protection and privacy, please press the Clear
This Form button after you have printed the form.
