Mendocino — CH-250

Source: http://www.courts.ca.gov/documents/ch250.pdf

CH-250 Proof of Service by Mail Clerk stamps date here when form is filed.

1 Name of Person Asking for Protection:

2 Name of Person to Be Restrained:

3 Notice to Server The server must: • Be 18 years of age or over. Fill in court name and street address: Superior Court of California, County of • Not be listed in items 1 , 2 , or 3 of form CH-100, Request for Civil Harassment Restraining Orders. • Mail a copy of all documents checked in 4 . to the person in 5 .

4 I (the server) am 18 years of age or over and live in or am employed Fill in case number: in the county where the mailing took place. I mailed a copy of all Case Number: documents checked below to the person in 5 : a. CH-120, Response to Request for Civil Harassment Restraining Orders b. CH-130, Civil Harassment Restraining Order After Hearing c. Other (specify):

5 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: State: Zip: c. Mailed on (date): d. Mailed from (city): (state): 6 Server ’s Information Name: Address: City: State: Zip: Telephone: If you are a registered process server: County of registration: 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 Server to sign here

Judicial Council of California, www.courts.ca.gov Proof of Service by Mail (CLETS) CH-250, Page 1 of 1Rev. September 1, 2022, Optional Form Code of Civil Procedure, § 527.6 (Civil Harassment Prevention) For your protection and privacy, please press the Clear This Form button after you have printed the form. Print this form Save this form Clear this form