Amador — WV-250

Source: https://amador.courts.ca.gov/system/files/forms-and-filings/wv250.pdf

Proof of Service of Clerk stamps date here when form is filed. WV-250 Response by Mail To keep other people from seeing what you entered on 1 Petitioner (Employer) your form, please press the Name: Clear This Form button at the end of the form when finished. 2 Employee in Need of Protection Name:

3 Respondent (Person From Whom Protection Is Sought) Name: Fill in court name and street address: 4 Notice to Server Superior Court of California, County of 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 Fill in case number: Case Number: checked in 5 below to the petitioner or the petitioner’s lawyer. • Complete and sign this form and give it to the respondent. 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: State: Zip: c. On (date): Mailed from: City: State:

7 Server’s Information Name: Telephone: Address: City: State: Zip: (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

Judicial Council of California, www.courts.ca.gov Revised January 1, 2012, Optional Form Proof of Service of Response by Mail WV-250, Page 1 of 1 Code of Civil Procedure, § 527.8 (Workplace Violence Prevention)

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