WV-250 Proof of Service of Response by Mail Clerk stamps date here when form is filed. 1 Petitioner (Employer) Name: 2 Employee in Need of Protection Name: 3 Respondent (Person From Whom Protection Is Sought) Name: 4 Notice to Server The server must: · Be 18 years of age or older. · Be a resident of or employed in the county where the mailing took place. · Not be the respondent. · Mail a copy of all documents checked in 5 below to the petitioner or the petitioner's lawyer. Complete and sign this form and give it · to the respondent. Fill in court name and street address: Superior Court of California, County of Fill in case number: Case Number: PROOF OF SERVICE BY MAIL 5 I am 18 years of age or older and not a party to this proceeding. I am live or am employed in the county where the mailing took place. I mailed the petitioner or the petitioner's lawyer a copy of: a. Form WV-120, Response to Petition for Workplace Violence Restraining Order (completed) b. Other (specify): 6 I placed copies of the documents listed above in a sealed envelope and mailed them as described below: a. Mailed to (name): b. To this address: City: c. On (date): 7 Server's Information Name: Address: City: (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: State: Zip: Telephone: Mailed from: City: State: Zip: State: Type or print server's name Judicial Council of California, www.courts.ca.gov Revised January 1, 2012, Optional Form Code of Civil Procedure, § 527.8 Server to sign here Proof of Service of Response by Mail (Workplace Violence Prevention) WV-250, Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com