Proof of Service PersonalCal. Super. - 6th Dist.November 21, 2018r , -l "Yerkslamps date herewhenform ix'filed. c- SC-104 «Proofci: r erviceg-Auuw-~i~#w \~~ A v r. -» furlwfi fl .. ' _‘: ‘j‘ z; _ ..Use this form to serve a person, a business, or a public entity. To learn more about proofofservice, read What Is "ProofofService"?, Form SC-104B To learn more about how to serve a business or entity, read How to Serve a Business or Public Entity, Form SC-104C. To serve a business, you must serve one ofthe following people: C I9" Of the Court Cl - Owner (for a sole proprietorship) Sup» ' Com °1Jsams ‘ aLr’aTY ' Partner (for a parmership) or general partner (for a limited partnership) BY“...- ‘, 24-:- ' ‘ v. .5? - Any officer 0r general manager (corporation or association) i ' Any person authorized for service by the business (corporation, association, general partnership, Fill in court n zme and street address:- limited partnership) Superior Co Irt of California - Any person authorized for service with the Secretary of State (coxporation, association, limited County 0f SI! I113 Clara liability company [LLC], limited liability pamership [LLP], limited partnership) '91 NORTH FIRST STREET To serve a public entity, you muSt first file a claim with that entity, then serve one of the following SAN JOSE’ (A 95 l l3 people: Fill in case number, case name, hearing dare, day. . ti . dd a t lb l .' - Clerk (of a cxty or county) me a" ep r men e 0W - Chief officer or director (of a public agency) case Numb 3r: ”sums“ - Any person authorized for service by the entity Case Namell a. If you are serving a person, wn'te the person’s name below: OPORI U“ D C‘ Again“ Jorge Gustavo Hernandez Hinojosa Jorge Gustavo Hernandez Hinojosa b. If you are serving a busihess or entity, write the name ofthe business or Hearing Da e: entlty, the person authonzed for serwce, and that person’s Job tltle: 1/3 1/2019 . l Business or Agency Name $315121“ ?Sept" Person Authorized for Service Job Title ® Instructions t0 Server: You must be at least 18 years old and not be named in this case. Follow these steps: v Give a copy of all the documents checked in ® to the person in ®, or ° Give a copy of all the documents checked in ® to one of the following people: a. A competent adult (at least 18) living with, and at the home of the person in @, or b. An adult (at least l8) who seems to be in charge at the usual workplace ofthe person in (D or c. An adult (at least 18) who seems to be in charge where the person in © usually receives i1 (but uot a U.S. Post Office box), ifthere is n0 known physical address for the person in ®mI and mail a copy of the documents left with one of the adults in a, b, 0r c above t0 the perso in ®. THEN ° Complete and sign this form, and ° Give 0r mail your completed form to the person who asked you to serve these court papers, in 'imefor theform to befiled with the court at least 5 days before the hearing. ® I served the person in (D a copy of the documents checked below: a. E SC-lOO, Plainnfl’s Claim and ORDER t0 G0 to Small Claims Court b. D SC-lZO, Defendant’s Claim and ORDER to Go t0 Small Claims Court @O4w c. D Order for examination (Thisform must be personally served. Check theform that was served). Note: The court can issue a civil arrest warrant ifthe servedparry does n01 come to court only fifthe orderfor examination was personally served by a registeredprocess server, sherifi: marshal, 0r someone appointed by the court. (1) D SC-l34, Application and Order t0 Produce Statement ofAssets and t0 Appearfor Examinatior (2) D AT-l38/EJ-125, ApplicatiOn and Orderfor Appearance and Examination d, E Other (Specgy); NOTICE To LITIGANTS; NOTICE To SMALL CLAN LITIGANT v.1 JudidalCoundlofCafifonfla. www.oourtinfo.ca.gov Proof of Service Case’ [Di 5361801 Revised January 1. 2009. Optional Form . _ Code ofCMI Procedure, §§ 11s.340.415.1o.41520 (small Clams) SC 104’ Page 1 °f2 ‘n’l HAVI‘JTW _C_a_se-N'umber: 188C076556 .7 15 7 w. ' f._FilITfif“§” '6?“b”‘5;__. 3v? ' w J‘ w; i E Personal Service: I personally gave copies of the documents checked in ® to the person in ® :g 0n (date): 12/7/2018 At (time): 8:50 PM Gender: MALE Age: 3 1-35 Skin Tone: MODERATE BROWN Hair: Black Eye Color: BROWN Height: 6fi Oin - 6ft 3in Weight: 151 lbs - 170 lbs At this address: Home: 5614 CALMOR AVE APT 4 City: SAN JOSE b. D Substituted Service: Ipcrsonally gave copies ofthe documents checked in ® (a D A competent adult ‘(at least 18) at the home of, and living with the person in D An adult who seems to be in charge where the person_in ® usually works,c D An adult who seems to be in charge where the person in ® usually receives office box (not a U.S. Post Office box), if there is no known physical addres Itold that adult, “Please give these court papers to (name ofperson in (0).” I did this on (date): At (time): At this address: State: CA _ b or d) to (check one): Zip: 95123 b, CI" mail, or has a p ivate post . for the person i ®. OI' City: State: Zip: Name or description ofthe person I gave the papers. to. After serving the court papers, Iput copies of the documents listed'1n ® 1n an envel and put first-class prepaid postage on it. I addressed the envelope to the person in C the ccpies [mailed the envelope on (date): fiom (city, state): ape, sealed the envelope, at the address where I left by leaving it (check one): _a. U At a U.S. Postal Service mail dr0p, or .b. 'D At an office or business mail drop where I know the mail is picked up every clay and depositei with the U.S. Postal Service, or c. D With someone else I asked to mail the documents to the person in ®, and I have attached tha person’s completed Form SC-104A. ® Agency Information: Name: Legal PurSuit Phone: 4082884105 Address: 22 West St: John St. Suite B City: San Jose State: CA Zip: 951 13 County ofregistation: SANTA CLARA . Registration number: PS 1658 Fee for service: $ 55.00 Process Server Information: County of registration: SANTA CLARA . Registration numb er: P $1658 © I declare under penalty of-perjur'y under California state law that I am at least 18 years old and not named in this case and that the information above is true and correct. Date l1.» 2 MARILYN ROJAS > MMx (2% Type orprint server 's name Server signs herelafte'r serving Revised January 1. 2009 Proof of Service (Small Claims) ‘7'" HAVWTT" Case ID: 5361801 SC-.1 0 4, Page 2 of _2
