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CH-131 Proof of Service by Mail (California)

This form is proof of mailing a protective order in a criminal proceeding in California. The form provided here is simply a sample of what the actual Form CH-131 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-131 Proof of Service by Mail

1. Name of person asking for protection: _________________________

2. Your name: _________________________

3. Notice to Server

The server must:

• Be over 18 years of age.

• Be a resident or employed in the county where the mailing took place.

• Not be a party in the case.

• Mail a copy of all documents checked in 4 to the person in 1. Complete and sign this form, and give or mail it to the person in 2.

Proof of Service by Mail

4. I am over 18 years of age and am a resident or employed in the county where the mailing took place. I mailed the person in 1 a copy of the documents checked below:

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

b. ____ Other (specify): _________________________

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

a. Mailed from (City): _________________________

(State): _________________________

b. On (date): _________________________

c. To 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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