EA-200 1 2 Name: Proof of Personal Service Clerk stamps date here when form is filed. Elder or Dependent Adult in Need of 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 , 3 , or 6 of Form EA-100. 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 . Superior Court of California, County of PROOF OF PERSONAL SERVICE 4 Court fills in case number when form is filed. I gave the person in 2 a copy of the forms checked below: a. EA-109, Notice of Court Hearing b. EA-110, Temporary Restraining Order c. EA-100, Request for Elder or Dependent Adult Abuse Restraining Orders d. EA-120, Response to Request for Elder or Dependent Adult Abuse Restraining Orders (blank form) e. EA-120-INFO, How Can I Respond to a Request for Elder or Dependent Adult Abuse Restraining Orders? EA-130, Elder or Dependent Adult Abuse Restraining Order After Hearing f. g. EA-250, Proof of Service of Response by Mail (blank form) h. EA-800, Proof of Firearms Turned In, Sold, or Stored (blank form) Other (specify): i. I personally gave copies of the documents checked above to the person in 2 : a. On (date): c. At this address: City: State: Zip: b. At (time): a.m. p.m. Case Number: 5 6 Server's Information Name: Address: City: 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 State: Zip: Judicial Council of California, www.courts.ca.gov Revised July 1, 2014, Optional Form Welfare & Institutions Code, § 15657.03 Proof of Personal Service (Elder or Dependent Adult Abuse Prevention) EA-200, Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com