Proof of Service PersonalCal. Super. - 6th Dist.November 6, 2018_ Clerk stamps date here when form is filed‘ SC- 04 Proof of Servuce ‘ Use [his form lo scrvc a person, a business, 0r a public entity. To lcam more about proofol‘scrvicc, read What Is "Proo ofService”?, Form SC- l 04B. To learn morc about how lo scrvc 21 business or cnlily, read Hour Io Serve a Businem or Public Enliry, Form SC-IO4C. To scrvc a business, you must scrvc one oflhc following pcoplc: - Owncr (for a solc proprietorship) A County 01 Santa Clara. Partner (for a partnership) or general panI-1cr (for a lin.1iI-cd partnership) BY DEPUTY - Any officer or general manager (corporation or assocmtlon) . . - Any person authorized for scrvicc by Ihc business (corporation, association, David Fifihelro gcncral partnership, limilcd partnership) Fill in coun name and street address: - Any person authorized for scrvicc with lhc Secretary ol‘SlalC (corporation, s”peri°" cw“ °f ca'ib'mav c°umy 0f association, limited liability company [LLC], Iimilcd liability partnership sum“ Clam [LLP], limited partnership) Small Claims |9| N. lstStrceI Sun Jose, California 95| 13 To scrvc a public entity, you must first filc a claim wilh that entity, Ihcn scrvc one oflhc following pcoplc: - Clcrk (ofa cily or county) - Chicfofficcr or director (ofa public agency) F’”'"" case ”“mbeh case ”amev “93"”9 da’er A1 crfion lulhori/cd for Servic b thc cnlil day' ”me' and depanmenfbelow" - I . ' 2 . c ' y p t . y . y , Case Number:® a. lfyou arc scrvmg a person, \vrltc Ihc person s name below: l8 SC 076346 ~ . ‘. h . . i V . Case Name: b. H you.arc scrvmg a buslncjss or ?nmy, .wrnc lhc name ol ”3c .busnycss Nolbeno Perez ct ul VS Jeff Luccro or cnllly, lhc person aulhonzcd [0r schIcc. and that person Sjob tltlc: er Ill Wcstside Manor HOA ofSan Jose ‘ A Busincss ur Agency Nun": Heanng Dam: 0 I /O9/20 l 9 c/o Linda Fricdrichs, President Pctsun Authorized for Service Job Titlc Time: 8-30 AM Dept: ] 5® Instructions to Server: You must bc at least l8 years old and not be named in this case. Follow thcsc steps: - Give a copy ofall thc documents checked in ® to lhc person in ®, 0r - Give a copy ofall the documents checked in® lo onc orthc following people: a. A competent adult (at Iczlst 18) living with, and at thc home 0fthc person in , or b. An adult (at least l8) who seems t0 bc in charge at thc usual workplace ot‘thc pcrson in G), or c. An adult (at least l8) who sccms to bc in charge whcrc the person in®usual|y rcccivcs mail (but not a U.S. Post Ol‘ficc box), it‘thcrc is no known physical address for thc person in®. and mail a copy ot‘thc documents lcft with onc ol'thc adults in n, b, 0r c above to thc person in G). THEN - Complete and sign this form, and ' Give 0r mail your completed form to thc person \vho asked you to scrvc lhcsc court papers, in Iimefor rliefllrm m befilcll with lllc court al Ieuxl 5 days bcfiIre Ihc hearing. ® l served the person in ® a copy of the documents checked below: O a. SC‘IOO, I’laimijf'x Claim and ORDER Ia Cu Io Small Cluimx Cnm-I b. D SC-lZO, Dejém/anl 'x Claim uml ORDER Io Gr) m Small Claimx Cour! c. D Ordcr for examination (Thisfm‘ln mtm‘l be pel‘xmmliy served, Check Ihe/brm Illa! wax .vervecl): Nule: The cum'! can i.\'.vuc u civil ru'ruxl wc/I'rmll [/"I/Iu .\'¢I'V¢L/pu;‘0r clucx not came In cmu'l mt/y i/‘Ihe urdcr/br e.\'amiuulim1 wax pemqu/[v xurvct/ by a I'egixlcrcdprawn .vurver. .v/tcri/If mam‘lml, or xomcmm appointed by Ihe court. (I ) D SC- l 34, Appliculion (Incl Orc/cr Ir) Produce SIaIe/nem ofAsseIs and I0 Appearjbr Examinalion (2) D AT- | 38/EJ- l 25, Application and Orderfol' Appearance (Incl Et‘aminalinn d_ omcr (Specify), Notice to Small Claims Litigunts JunidatCouncnotcmatomiatwwwlcounwaugov ' 80-104, Pa e 1 o! 2 Revised January I. 2009, Optional me PrOOf 0f se_W|ce g 9 Coda otCivitProcodum.§§ 116.340,415.1o,415.2o (Small Cialms) Case Number: l8 SC 076346 Case name; Nolberto Perez ct al vs Jeff Luccro CI al ® Fill out “a” or “b” below: a‘ Personal Service: I personally gave copies oi‘lhc documents checked in ® l0 thc person in®z On (dale),- lw- A1 (IiI'IC’)-' 628- D a.m. p.m AI lhis address: 3 I 95 scmcr Rd City; San JOSC Slate: CA Zip: 95] H b. D Substituted Service: l personally gave copies oflhc documents chcckcd in © (a, b, 0rd) lo (check one): D A compclcnl adult (al least l8) al Ihc home 0f, and living with the person in® , or D An adult who seems 10 bc in charge where Ihc person in© usually works, or D An adult who sccms lo be in charge whcrc Ihc person in®usually receives mail, or has a private post office box (not a U.S. Posl Office box), iflhcrc is no known physical address for the person in® l told that adult, "Please give Ihcsc courl papers Io (name ol‘pcrson in©." I did this on (dale): Al (lime): D a.m. D p‘m. Al lhis address: Cily: Slate: Zip: Name or description oflhc person I gave Ihc papers lo: A Rcr serving lhc court papers, I put copies oflhc documents listed in © in an cnvclopc, scaled the cnvclopc, and put firsI-class prcpaid postage on il. | addressed lhc cnvclopc Io lhc person in ® at lhc address whcrc I left lhc copies. | mailed lhc cnvclopc on (clutc);_____l'rom (oily, .vla/e): by [caving it (check one): a. D Al a U.S. Postal Service mail (IrOp, or b. D A1 an office 0r business mail drop \vhcrc | know lhc mail is picked up every day and dcposilcd with thc U.S. Postal Scrvicc, or 0D With someone clsc | asked to muil lhc documcnls to lhc person in ®, and I have attached that person’s completed Form SC-IO4A. © Server’s Information Name; Agustin S. Rodriguez phone: 408-569-4390 Addrcssr 3 I 80 Shofncr Placc City: San Jose slaw; CA Zip; 95] || [fyall (II‘L’ (I I'egiS/CI'C(I [)I'OCC’A‘A‘ SCI'VL’I‘.‘ County ofrcgistralion: Registration] number: ® I declare under pcnulry ofpcrjury under California state law that I am at least 18 years old and nol named in this case and that thc information ubovc is truc und corrcct. Dale: 11/19/2018 /' u Agustin S. Rodriguez h K 4/ 4--’ Type 0r print server 'x name Server SM here qf/cr .veHIing Revised January 1,2009 proof of service SC-104, Page 2 012 (Small Claims)
