DV-200 1 2 3 Proof of Personal Service Clerk stamps date here when form is filed. Name of Party Asking for Protection: Name of Party to Be Restrained: Notice to Server The server must: · Be 18 years of age or older. · Not be listed in items 1 or 3 of form DV-100, Request for Domestic Violence Restraining Order. · Give a copy of all documents checked in 4 to the restrained party in 2 (you cannot send them by mail). Then complete and sign this form, and give or mail it to the party in 1 . Fill in court name and street address: Superior Court of California, County of 4 I gave the party in 2 a copy of all the documents checked: Court clerk fills in case number when form is filed. a. DV-109 with DV-100 and a blank DV-120 (Notice of Court Case Number: Hearing; Request for Domestic Violence Restraining Order; blank Response to Request for Domestic Violence Restraining Order) DV-110 (Temporary Restraining Order) b. DV-105 and DV-140 (Request for Child Custody and Visitation Orders, Child Custody and Visitation Order) c. d. FL-150 with a blank FL-150 (Income and Expense Declaration) e. FL-155 with a blank FL-155 (Financial Statement (Simplified)) f. DV-115 (Request to Continue Hearing) g. DV-116 (Order on Request to Continue Hearing) DV-130 (Restraining Order After Hearing) h. i. Other (specify): I personally gave copies of the documents checked above to the party in 2 on: a. Date: b. Time: a.m. p.m. c. At this address: City: State: Zip: 5 6 Server's Information Name: Address: City: Telephone: (If you are a registered process server): County of registration: State: Zip: Registration number: 7 Date: I declare under penalty of perjury under the laws of the State of California that the information above is true and correct. Type or print server's name Judicial Council of California, www.courts.ca.gov Revised July 1, 2016, Optional Form Family Code, §§ 243, 245, and 6345 Server to sign here Proof of Personal Service (CLETS) (Domestic Violence Prevention) DV-200, Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com