Mendocino — WV-200

Source: http://www.courts.ca.gov/documents/wv200.pdf

WV-200 Proof of Personal Service Clerk stamps date here when form is filed. 1 Petitioner (Employer or Collective Bargaining Representative) Name: 2 Employee Who Suffered Harassment, Violence, or Threat of Violence 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. Not be listed in items 1, 2, or 4 of form WV-100. 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. Court fills in case number when form is filed. PROOF OF PERSONAL SERVICE Case Number: 5 I gave the respondent a copy of the forms checked below: a. WV-109, Notice of Court Hearing b. WV-110, Temporary Restraining Order c. WV-100, Petition for Workplace Violence Restraining Orders d. WV-120, Response to Petition for Workplace Violence Restraining Orders (blank form) e. WV-120-INFO, How Can I Respond to a Petition for Workplace Violence Restraining Orders? f. WV-130, Workplace Violence Restraining Order After Hearing g. WV-250, Proof of Service by Mail (blank form) h. WV-800, Receipt for Firearms, Firearm Parts, and Ammunition (blank form) i. Other (specify): 6 I personally gave copies of the documents checked above to the respondent a. On (date): b. At (time): a.m. p.m. c. At this address: City: State: Zip: 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, courts.ca.gov WV-200, Page 1 of 1Rev. January 1, 2026, Optional Form Proof of Personal Service Code Civ. Proc., §§ 527.8, 1011 (Workplace Violence Prevention) For your protection and privacy, please press the Clear button after you have printed the form. Print Save Clear