Proof of Service PersonalCal. Super. - 6th Dist.August 7, 2019Clerk stamps date here when form is| filed. Proof of Service ' -- . Use this form t0 serve a person, a business, or a public entity. T0 learn more about proof ofservice, read What Is ”ProofofService"?, Form SC-104B. To 16am more about how to serve a business 0r entity, read How to Serve a Business 0r Public Entity, Form SC-l 04C. To serve a business, you must serve one ofthe following people: ' Owner (for a sole proprietorship) - Partner (for a partnership) 0r general partner (for a limited partnership) ° Any officer or general manager (corporation or association) - Any person authorized for service by the business (corporation, association, ‘ general partnership: lhnited partnership) Fill in court name and street address:- - Any person authorized for service with the Secretary 0f State (corporation, S“peri°r 0‘3”“ °f calmmia' county °f association, limited liability company [LLC], limited liability partnership [LLP], limited partnership) T0 serve a public entity, you must first file a claim with that entity, then serve one ofthe following peeple: ° Clerk (of a city or county) . Chief officer Ol- director (Of a public agency) Fm in pase number, case name, heéring dare, . . . day; t1me. and department befow: - Any person authorlzed for serv1ce by the entlty c N b ; C® a Ifo are serving a person, write the person’s name below: ase um er //-YL 077¢V0A Lama ac, é 592‘?E‘fglg jammy pr: {mb Ifyou are serving a bu mess or entity, write the name of the business fly Ww7yz or entity, the person authorized for service, and that person’ s job title: 4/ 60AIM flfl/mEvaég Business or Agency Name Hearing Date Qfl7/fl9A 7 Person Authorized for Service Job Title Time! y?! flM Deth‘ /f I® Instructions to Server: You must be at least 18 years old and not be named in this case. Follow these steps: ° Give a copy of all the documents checked in© to the person in ®, or SEP 2 o 2019’ a'zé Clerk 0i the COLIN Superior Coun-Civil Dim'sion 191 N. FirstSt. San Jose. CA 95113 Give a copy of all the documents checked in® to one of the following people: a A competent adult (at least 18)}iving with, and at the home 0fthe person in ,or b. An adult (at least 18) who seems t0 be 1n charge at the usual workplace 0f the person in® 0r c An adult (at least 18) who seems to be 1n charge where the person in @usually receives mail (but not a U S. Post Office box), if there ls n0 known physical address for the person in®. and mail a copy 0fthe documents left with one 0f the adults in a, b, or c above to the person i116). THEN - Complete and sign this form, and ° Give or mail your completed form t0 the person who asked you to serve these court papers, in timefor theform to befiled with the court at least 5 days before the hearing. © | sewed the person in G) a copy of the documents checked below: . a. D SC-IOO, Plaim‘z'fi’s Claim and ORDER t0 Go t0 Small Claims Court &b. E80120, Defendant’s Claim and ORDER t0 G0 t0 Small Claims Court w c. D Order for examination (Thisform must be personally served. Check rheform that was served): Note: The court can issue a civil arrest‘warrant ifthe servedparty does not come r0 court only ifthe orderfor examination was personally served by a registeredprocess server, sherifi marshal, or someone appointed by the c0 urr. (1) D SC-134, Application and Order r0 Produce Statement ofAssers and t0 Appearfor Examiniation (2) D AT-lBS/EJ-IZS, Application and Orderfor Appearance and Examination d. D Other (specz'fii): Judicial Council of California, mvwmurfinhcagov ' . SC-‘l 04 Page ‘l 0f 2 Revised January 1, 2009, Optional Form PrOOf 0f se_che ’ 9 Code of Civil Procedure, §§ 116.340, 415.10, 41520 (Small Claims) Case Number: ; ' ‘ ‘9 Casename; Reynaldo Soriano &Kim Levesque v Gower ‘ 198C079900 ® Fill out “a” or “b” below: "af- E’ Personal Service: Ipersonally gave copies 0fthe documents checked in© t0 the person in®z 0n (date): ?gtzvé'll‘i At (time): Z \vi 3' D a‘mi KPH]. ' At this address: [9-777 *x4CBCHUIYLQS D1” 1% 2‘?! City? S Unmvmle’fifiq- . State'M Zip: ?@ $6 b. D Substituted Service: Ipersonally gave copies 0f the documents checked in C3) (a, b, 0r a) t0 (check one): D A competent adult (at least 18) at the home of, and living with the person inC‘D , or ~ v -g A11 adult who seems to be infiharge where-the person in® usually worksror -_- ~- h D A11 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 no known physical address for the person in@. Itold that adult, "Please give these court papers to (name of person in®." Idid this on (daze): At (time): D am. D pm. At this address: City: . State: Zip: Name or description 0f the person I gave the papers t0: After sewing the court 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 lefi the copies. - Imailed the envelope 0n (date) fi‘om (city, state): by leaving it (check one): a. D At a U.S. Postal Service mail drop, or b. B 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 o.D With someone else I asked to mail the documents t0 the person in (D, and I have attached that person’s completed Form SC-104A. ® Server’s Information Name: fl/[OW-l-HQ {o7 afflr/Z/ Phone: 6202))2- [0" gq?0 Address: 100 *SaVQZ-{Hcg/ML ¢W~ fl floor? City: 5 mea flfam 7 r State; a4 Zip: Zfar/ . W Fee for service: $ W- Ifyou are a registeredprocess server“ county 0f registration: s :S 2‘ {EL E l O g =c glfiy a/W&Registration number: f ggfl: © I declare hnderpenalty of perjury 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:w /M awLm Gavan ' ’ WMfl/L Type orprint server ’s name Serv signs here afier serving Revised January 1, 2M Proof 0f Service 8C4 04. Page 2 Of 2 (Small Claims)
