
EA-250, Page 1 of 1
Proof of Service of Response by Mail
(Elder or Dependent Adult Abuse Prevention)
EA-250
Proof of Service of
Response by Mail
Judicial Council of California, www.courts.ca.gov
Rev. January 1, 2012, Optional Form
Welfare & Institutions Code, § 15657.03
The server must:
Notice to Server
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 person in a copy of all documents checked below:
Form EA-120, Response to Request for Elder or Dependent Adult Abuse Restraining Orders (completed)
I declare under penalty of perjury under the laws of the State of California that the information above is true and
correct.
Other (specify):
Clerk stamps date here when form is filed.
PROOF OF SERVICE BY MAIL
3
4
1
Fill in court name and street address:
Superior Court of California, County of
Case Number:
Fill in case number:
Server’s Information
Name:
Address:
Zip:
State:City:
Telephone:
(If you are a registered process server):
Registration number:
County of registration:
6
Date:
Type or print server’s name
Server to sign here
Name:
1
2
Person From Whom Protection Is Sought
Your Name:
Elder or Dependent Adult Seeking Protection
b.
a.
5
Be 18 years of age or older.
Mail a copy of all documents
checked in to the person in .
Complete and sign this form and give
it to the person in .
•
•
•
14
2
Be a resident of or employed in the
county where the mailing took place.
•
Not be listed in items , , or of
Form EA-100.
•
1
3
6
I placed copies of the documents checked above in a sealed envelope and mailed them as described below:
Zip:
State:
City:
Mailed to (name):
On (date): Mailed from:
City:
State:
To this address:
a.
c.
b.