Form Ch-120 - Response To Request For Civil Harassment Restraining Orders Page 9
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9Proof of Service of Response by
CH-250
Clerk stamps date here when form is filed.
Mail
Person Seeking Protection
1
Name:
Person From Whom Protection Is Sought
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Your Name:
Notice to Server
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The server must:
Be 18 years of age or older.
Fill in court name and street address:
Live or be employed in the county
Superior Court of California, County of
where the mailing took place.
Nevada
Not be listed in items
or
of Form
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201 Church Street
CH-100.
Nevada City, CA 95959
Mail a copy of all documents
checked in
to the person in
.
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Complete and sign this form and give
Fill in case number:
it to the person in
.
2
Case Number:
PROOF OF SERVICE BY MAIL
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
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mailing took place. I mailed the person in
a copy of all documents checked below:
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a. Form CH-120, Response to Request for Civil Harassment Restraining Orders
b.
Other (specify):
I placed copies of the documents checked above in a sealed envelope and mailed them as described below:
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a. Mailed to (name):
b. To this address:
City:
State:
Zip:
c.
On (date):
Mailed from: City:
State:
Server's Information
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Name:
Address:
City:
State:
Zip:
Telephone:
(If you are a registered process server):
County of registration:
Registration number:
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
Server to sign here
CH-250,
Page 1 of 1
Judicial Council of California,
Proof of Service of Response by Mail
Rev. January 1, 2012, Optional Form
Code of Civil Procedure, § 527.6
(Civil Harassment Prevention)
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