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