CH-200
Proof of Personal Service
Clerk stamps date here when form is filed.
Fill in court name and street address:
Superior Court of California, County of
Court fills in case number when form is filed.
Case Number:
Notice to Server
The server must:
Be 18 years of age or older.
Not be listed in items or
of Form CH-100.
1
3
I gave the person in a copy of the forms checked below:
Give a copy of all documents checked in to the person in .
(You cannot send them by mail.) Then complete and sign this
form and give or mail it to the person in .
a.
c.
f.
g.
I personally gave copies of the documents checked above to the person in :
Zip:
State:
Server's Information
Name:
Address:
Zip:
City:
Telephone:
(If you are a registered process server):
Registration number:
County of registration:
State:
I declare under penalty of perjury under the laws of the State of California that the information above is true and
correct.
CH-200, Page 1 of 1
Proof of Personal Service
(Civil Harassment Prevention)
d.
h.
e.
•
•
•
PROOF OF PERSONAL SERVICE
3
6
4
5
2
2
1
4
b.
2
1
2
Person From Whom Protection Is Sought
Person Seeking Protection
Name:
Name:
CH-109, Notice of Court Hearing
CH-110, Temporary Restraining Order
CH-120, Response to Request for Civil Harassment Restraining Orders (blank form)
CH-100, Request for Civil Harassment Restraining Orders
CH-120-INFO, How Can I Respond to a Request for Civil Harassment Restraining Orders?
CH-800, Proof of Firearms Turned In, Sold, or Stored (blank form)
CH-130, Civil Harassment Restraining Order After Hearing
Other
(specify):
Server to sign here
Date:
Type or print server’s name
a.
b.
On (date):
At (time):
At this address:
City:
Judicial Council of California, www.courts.ca.gov
Revised July 1, 2014, Optional Form
Code of Civil Procedure, § 527.6
a.m.
p.m.
c.
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