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This is a California form that can be used for Elder Or Dependent Adult Abuse within Judicial Council.
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EA-250 1 Name: 2 3 Proof of Service of Response by Mail Clerk stamps date here when form is filed. Elder or Dependent Adult Seeking Protection Person From Whom Protection Is Sought Your Name: 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 listed in items 1 , 3 , or 6 of Form EA-100. · Mail a copy of all documents checked in 4 to the person in 1 . · Complete and sign this form and give it to the person in 2 . · · Fill in court name and street address: Superior Court of California, County of Fill in case number: Case Number: PROOF OF SERVICE BY MAIL 4 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 1 a copy of all documents checked below: a. Form EA-120, Response to Request for Elder or Dependent Adult Abuse Restraining Orders (completed) b. Other (specify): 5 I placed copies of the documents checked above in a sealed envelope and mailed them as described below: a. Mailed to (name): b. To this address: City: c. On (date): Mailed from: City: State: Zip: State: 6 Server's Information Name: Address: City: 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: State: Zip: Type or print server's name Judicial Council of California, www.courts.ca.gov Rev. January 1, 2012, Optional Form Welfare & Institutions Code, § 15657.03 Server to sign here Proof of Service of Response by Mail (Elder or Dependent Adult Abuse Prevention) EA-250, Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com