Amador — CH-200

Source: https://amador.courts.ca.gov/system/files/forms-and-filings/ch200.pdf

CH-200 Proof of Personal Service Clerk stamps date here when form is filed.

1 Person Seeking Protection Name: 2 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 or 3 Superior Court of California, County of of form CH-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 . PROOF OF PERSONAL SERVICE Court fills in case number when form is filed. 4 I gave the person in 2 a copy of the forms checked below: Case Number: a. CH-109, Notice of Court Hearing b. CH-110, Temporary Restraining Order c. CH-100, Request for Civil Harassment Restraining Orders d. CH-120, Response to Request for Civil Harassment Restraining Orders (blank form) e. CH-120-INFO, How Can I Respond to a Request for Civil Harassment Restraining Orders? f. CH-130, Civil Harassment Restraining Order After Hearing g. CH-250, Proof of Service by Mail (blank form) h. CH-800, Proof of Firearms Turned In, Sold, or Stored (blank form) i. Other (specify): 5 I personally gave copies of the documents checked above to the person in 2 : a. On (date): b. At (time): a.m. p.m. c. At this address: City: State: Zip: 6 Server ’s Information Name: Address: City: State: Zip: 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

Judicial Council of California, www.courts.ca.gov CH-200, Page 1 of 1Rev. September 1, 2022, Optional Form Proof of Personal Service 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