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CH-130 Proof of Personal Service (California)

This form is proof of serving a restraining order, proof of firearms turned in or sold, orders to stop harassment, notice of hearing, etc. in a criminal proceeding in California. The form provided here is simply a sample of what the actual Form CH-130 looks like.


Clerk stamps date here when form is filed. _________________________

Fill in court name and street address:

Superior Court of California, County of _________________________



Case Number: _________________________


CH-130 Proof of Personal Service

1. Name of person asking for protection: _________________________

2. Name of person you want protection from: _________________________

3. Notice to Server

The server must:

• Be over 18 years of age.

• Not be listed on the restraining order.

• 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

4. I gave the person in 2 a copy of the documents checked below:

a. ____ CH-120, Notice of Hearing and Temporary Restraining Order (CLETS)

b. ____ CH-100, Request for Orders to Stop Harassment

c. ____ CH-110, Answer to Request for Orders to Stop Harassment (blank form)

d. ____ CH-145, Proof of Firearms Turned In or Sold (blank form)

e. ____ CH-151, How Can I Answer a Request for Orders to Stop Harassment?

f. ____ CH-140, Restraining Order After Hearing to Stop Harassment

g. ____ 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 _________________________

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