Notice to Server b. d. County of registration: City: State: Zip: Telephone: Name: Address: Server’s Information6 a. c. b. c. a. I (the server) am 18 years of age or over and live in or am employed in the county where the mailing took place. I mailed a copy of all documents checked below to the person in : 5 I placed copies of the documents checked above in a sealed envelope and mailed them as described below: If you are a registered process server: Be 18 years of age or over. Mail a copy of all documents checked in to the person in .

Not be listed in items , or of form DV-100, Request for Domestic Violence Restraining Order. Clerk stamps date here when form is filed. Fill in court name and street address: Superior Court of California, County of Fill in case number: Case Number: DV-112, Waiver of Hearing on Denied Request for Temporary Restraining Order DV-120, Response to Request for Domestic Violence Restraining Order FL-150, Income and Expense Declaration f. Other e. DV-130, Restraining Order After Hearing (Order of Protection) d.

FL-155, Simplified Financial Statement DV-250 Proof of Service by Mail Judicial Council of California, www.courts.ca.gov Revised January 1, 2020, Optional Form Family Code, §§ 6324, 6340-6344 Proof of Service by Mail (CLETS) (Domestic Violence Prevention) DV-250, 1 2 Name of Person Asking for Protection: Name of Person to Be Restrained: 21 3 4 5 5 (specify): The server must: • • • To this address: Name of person served: Mailed on (date): Mailed from (city): Zip:State:City: (state): Registration number: Server to sign here 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