Proof of Service SubstitutedCal. Super. - 6th Dist.June 12, 2019h SC-1 04 Proof of Service Use this form t0 serve a person, a business, 0r a public entity. T0 learn more about proof of service, read What Is ”ProofofService"? , Form SC-104B. To learn more about how to serve a business or entity, read How (0 Serve a Business 0r Public Entity, Form SC-104C. To serve a business, you must serve one OfIhe following people: o Owner (for a sole proprietorship) o Partner (for a partnership) or general partner (for a limited partnership) o Any officer or general manager (corporation or association) o Any person authqrized for service by the business (corporation, association, general partnershlp, limited pannership) o Any person authorized for service with the Secretary 0f State (corporation, association, limited liability company [LLC], limited liability partnership [LLP], limited partnership) To serve a public entity, you must first file a claim with that entity, then secve one offhe following people: o Clerk (0f a city or county o Chief officer or director 0f a public agency) o Any person authorized for service by the entity a. Ifyou are serving a person, write the person's name below: SOHAILA SHOOSHTARIAN b. Ifyou are serving a business 0r entity, write the name 0f the business or entity, the person authorized for service, and that person's job title: Business or Agency Name P613011 Authorized for Service Instructions to Server: Job Title Clerk stamps dare here when form is filed. ’ of the Court Pounty o! S&Tta Clara Fm in court rg‘émgaanffigipegrgg’dress: Superior Court of California, County of SANTA CLARA l9]. N FIRST ST. SAN JOSE, CA 95113 Fill in case number, case name, hearing dare, day. time, and department below: Case Number: l9SCO 7 923 2 Case Name: Hearing Date: 09/17/2019 Time: Dept.: 8:30AM l4 ' You must be at least 18 years 01d and not be named in this case. Follow these steps: a Give a copy of all the documents checked in© 'to the person in® , 0r o Give a co‘py 0f all the documents checked in® to one of the following people: a. A campetent adult (at least 18) living with, and at the home ofthe person in® , 0r b. An adult (at least 18) who seems to be in charge at the usual workplace 0f the person in® , or c. An adult (at least 18) who seems t0 be in charge where the person in ® usually receives mail (but not a U.S. Post Office box), ifthere is no known physical address for the person in® and mail a copy 0fthe documents left with one ofthe adults in a, b, or c above to the person in® ~ THEN o Complete and sign this form, and . Give or mail your completed form to the person who asked you to serve these court papers, in time for theform t0 befiled with the court at least 5 days before the hearing. l served the person in ® a copy of the documents checked below: a. m SC-IOO, Plaintsz’s Claim and ORDER t0 Go to Small Claims Cour! b. D SC-120, Defendantis Claim and ORDER t0 Go f0 Small Claims Court fig} c. D Order for examination (Tirisform must be personally served. Check tfzeform that was served): Note: The court can issue a civil arrest warrant z'ftize servedparzfy does no! come t0 court only tfthe orderfor examination was personally served by a registeredprocess server, sheriff marshal, 0r someone appointed by the court. (1)D SC-134, Application and Order t0 Produce Statement ofAssets and t0 Appearfor Examination (2)D AT-l 38/EJ-125, Application and OrderforAppearance and Examinarion d. D Other (specifiz): jualpla CounCI Oftallomla, mmmcoumnrocayov Rewsed January ‘l. 2009 Optional Form Code o! CMI Procedure. §§ 116.340. 415.10. 415.20 CEB‘ cebtom Proof of Service Essent'a' (Small Claims)EFormS' SC-104', Page1 of2 9 Case Number: ' Case name: I u l Fill out "a" or "b" below: a. D Personal Service: Ipcrsonally gave copies 0f the documents checked in © to the person in © : On (date):-- At (time):-__D am. D p.111. 1At this address: City: State: Zip: J b. fl Substituted Service: Ipersonally gave copies of the documents checked in ©(a, b, 0r d) t0 (cjlzeck one): m A competent adult (at least 18) at the home of, and living with the person in® , 0r ‘ D An adult who seems to be in charge where the person in ® usually works, or D An adult who seems to be in charge where the person in ® usually receives mail, or has a private post office box (not a U.S. Post Office box), if there is n0 known physical address for the person in®. Itold that adult,"PIease give these court papers to (name of perSOn in®)." Idid this on (date): 0 8 / 2 1 / 2 o 1 9 At (time):1;15_ D am. m pm. im ‘ Rfifis éfid’res’s: "5‘7 IAREEER'ED-E‘fio 'finfffl1T7 ' ’ “ ‘ H City: PALO ALTO State: CA Zip: 94 2 04 Name or description of the person I gave the papers t0: After serving the coun papers, I put copies of the documents listed in @in an envelope, sealed the envelope, and put first-class prepaid postage 0n it. I addressed the envelope to the person in ®at the address where I left the copies. I mailed the envelope on (date): _0_8_L2J_,L2_0_19_fr0m (city, state): by leaving it (check one): a. D At a U.S. Postal Service mail drop, or ' b. m At an office or business mail drop where I know the mail is picked up every day and deposited with the U.S. Postal Service, 0r c D With someone else I asked t0 mail the documents to the person in (D, and 1 have attached that person's completed Form SC-104A. ® Server's Information Name: BENJAMIN STURGES PhonezA08-291-5000 Address: 31 N 2ND ST #22 ‘ City: 'SAN JOSE ‘ - - -- -' ~ State: CA- -- v Zip:951-1-3 - -- - m‘ 4; Fee for service: $-'15 Ifyou are a registeredprocess server: County of registration: SANTA CLARA Registration number: 1 E '7 6 ® I declare under penalty 0f perjury under California state law that I am at least 18 years 01d and not named in thiscase and that the information above is true and correct. Date: 08/21L2019 BENJAMIN STURGES D Q/ Type orprint server’s name gvflr’fiéns here after serving Revised January 1. 2009 Proof of Service SC-1 04, Page 2 0f 2 CEB‘ Essenfla! (Sman Claims) (ehcom E F°_rmS_
