SV-250

Proof of Service of 
Response by Mail

Clerk stamps date here when form is filed.

1 Petitioner (Educational Institution Officer or Employee)

Name:

Name:

Name:

2 Student in Need of Protection

3 Respondent (Person From Whom Protection Is Sought)

4

Notice to Server
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
checked in       below to the petitioner 
or the petitioner’s lawyer.     
Complete and sign this form and 
give it to the respondent.      

5

•
•

•

Fill in court name and street address:

Superior Court of California, County of

Fill in case number:
Case Number:

PROOF OF SERVICE BY MAIL

I am 18 years of age or older and not a party to this proceeding. I 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 SV-120, Response to Petition for Private Postsecondary School Violence Restraining Orders (completed)
b.         Other (specify): 

I placed copies of the documents listed above in a sealed envelope and mailed them as described below:

5

6

Mailed from: City:

State:

State:

Zip:

a.
b.

Mailed to (name):

To this address: 
City:

c.

On (date):

7

Server’s Information

Name:

Address:

City:

Date:

(If you are a registered process server):

County of registration:

I declare under penalty of perjury under the laws of the State of California that the information above is true and 
correct.

Telephone:

State:

Zip:

Registration number:

Type or print server’s name


Server to sign here

Judicial Council of California, www.courts.ca.gov
Rev. January 1, 2012, Optional Form
Code of Civil Procedure, § 527.85 

Proof of Service of Response by Mail
(Private Postsecondary School Violence Prevention)

SV-250, Page 1 of 1