DV-250 1 2 3 Clerk stamps date here when form is filed. Proof of Service by Mail Name of Person Asking for Protection: Name of Person to Be Restrained: Notice to Server The server must: · Be 18 years of age or over. · Not be listed in items 1 or 2 or 3 of form DV-100, Request for Domestic Violence Restraining Order. · Mail a copy of all documents checked in 4 to the person in 5 . Fill in court name and street address: Superior Court of California, County of 4 I (the server) am 18 years of age or over and live in or am employed in Fill in case number: the county where the mailing took place. I mailed a copy of all Case Number: documents checked below to the person in 5 : DV-112, Waiver of Hearing on Denied Request for Temporary a. Restraining Order b. DV-120, Response to Request for Domestic Violence Restraining Order FL-150, Income and Expense Declaration c. FL-155, Simplified Financial Statement d. DV-130, Restraining Order After Hearing (Order of Protection) e. f. Other (specify): Note: You cannot serve DV-100, DV-105, DV-109, or DV-110 by mail. I placed copies of the documents checked above in a sealed envelope and mailed them as described below: a. Name of person served: b. To this address: City: c. Mailed on (date): d. Mailed from: City: State: 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 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 Rev. January 1, 2012, Optional Form Family Code, §§ 6324, 6340-6344 Server to sign here Proof of Service by Mail (CLETS) (Domestic Violence Prevention) DV-250, Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com