WV-200 1 2 3 Proof of Personal Service Clerk stamps date here when form is filed. Petitioner (Employer) Name: Employee in Need of Protection Name: Respondent (Person From Whom Protection Is Sought) Name: 4 Notice to Server The server must: · Be 18 years of age or older. · Not be listed in items 1 , 2 , or 4 of Form WV-100. Fill in court name and street address: Superior Court of California, County of · Give a copy of all documents checked in 5 below to the respondent. (You cannot send them by mail.) Then complete and sign this form and give or mail it to the petitioner. PROOF OF PERSONAL SERVICE 5 Court fills in case number when form is filed. I gave the respondent a copy of the forms checked below: WV-109, Notice of Court Hearing a. WV-110, Temporary Restraining Order b. WV-100, Petition for Workplace Violence Restraining Orders c. WV-120, Response to Petition for Workplace Violence Restraining Orders (blank form) d. WV-120-INFO, How Can I Respond to a Petition for Workplace Violence Restraining Orders? e. WV-130, Workplace Violence Restraining Order After Hearing f. WV-800, Proof of Firearms Turned In, Sold, or Stored (blank form) g. Other (specify): h. I personally gave copies of the documents checked above to the resondent a. On (date): c. At this address: City: b. At (time): a.m. p.m. Case Number: 6 State: Telephone: State: Zip: 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: Type or print server's name Server to sign here Zip: Judicial Council of California, www.courts.ca.gov Revised July 1, 2014, Optional Form Code of Civil Procedure, §§ 527.8, 1011 Proof of Personal Service (Workplace Violence Prevention) WV-200, Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com