Proof of Service PersonalCal. Super. - 6th Dist.February 28, 2020’ Clerk stamps date here when form 1's file d. SC-1 04 Proof of Service Use this form to serve a person, a business, or a public entity. T0 leam more j ”x E- E16:about proof 0f service, read Wfiat Is ’ProofofService"?, Form SC-104B. T0 ' Lg rm learn more about how to serve a business or entity, read How to Serve a D Business or Public Entity. Form SC-104C. Al R 1 5 2021 To serve a business, you must serve one 0f the following people: Clerk 0f ihe Court ° Owner (for a sole proprietorship) Stlpedm Coun or CA County or Santa cram - Any officer or general manager (corporation or association) ° Any person authorized for service by the business (corporation, association, general partnership, limited partnership) Ff” m COUJ'T namQ andsb'ee‘ address: - Partner (for a partnership) or general partner (for a limited partnership) BYEPUW ‘ . m ° Any person authorized for service with the Secretary of State (corporation, superim cw” °f ca'ifomia' county of association limned liability com any [LL01 limited liability partnership santa Clara LP 1. 3t d arm h. p ’ 191 North First Street [L 1’ “me p erg 1p) _ _ . San Jose, CA 95113 To serve a public entity, you must fimt file a clalm Wlth that entlty, then serve one 0f the following people: - Clerk (of a city 0r county) I ' Chief officer 0r director (of a public agency) H” i” 9839 ”um”, case "ame' ”93""9' date! . . . . d , ti , dd rtm tb I .-' Any person authonzed ior semce by the entlty :zsemsuzbeipa 9n e 0w (D a. Ifyou are serving a person, write the person’s name below: éOSCO 8277 2 Re €9ro T“ ofcflefi R\aefa b. Ifyou are serving a business or entity, write the name of the business 0r entity, the person authorized for service, and that person’s job Ititle: Case Name: Embaye vs. Rivera A Hearing Date: Busmess or Agency Namc May 17 , 2021 Person Authorized for Service Job Title T'me: 8 z 3 0 am Dept: 2 2® 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 (D, or - Give a copy of all the documents checked in© to one ofthe 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 18) who seems to be in charge at the usual workplace ofthe person in ®, 0r c. An adult (at least 18) who seems to be in charge where the person in ®usually receives mail (but not a U.S. qut Office box), if there is no known physical address for the person in©. and mail a copy of the documents lefi with one of the adults in a, b, 0r c above to the person in (D 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 timefor theform t0 befiled with the court at least 5 days before the hearing. ® l served the person in CI) a copy of the documents checked below: ( E - O a. D SC-lOO, Plaintzfi‘k Claim and ORDER to G0 t0 Small Claims Court ' b. D SC-120, Defendant’s Claim and ORDER t0 Go t0 Small Claims Court c. Order for examination (Thisform must be personally served. Check theform that was served): Note: The court can issue a civil arrest warrant ifthe servedparty does not come to court only {/‘the orderfor examination was gersonally served by a registeredprocess server, shenfi: marshal, 0r someone appointed by the court. (1) D SC-134, Application and Order to Produce Statement ofAssets and t0 Appearfor Examination (2) AT-138/EJ-125, Application and Orderfor Appearance and Examination d. D Other (specw): Judicial Couna‘lotmrrr 1a. .cowfinromgov ' SC-1 04. Pa e 1 of 2 Revised Januany 1.200Zn0pm Fonn PrOOf Of servlce C‘EB g 9 Code crown Proeedwe_§§ 11a340.415.1o,41520 (Small Claims) m_ceb_com Case Number: 2 080082772 Case name; Embaye vs . Rivera @ Fill out “a" or “b" below: a. Q Personal Service: I personally gave copies of the documents checked in® to the person in (D: On (date): 3/26/21 At (”’7”):_2_5£_- D a.m. p.m. At this addrgss; 701 Kings Row, Suite 92F city;San Jose State; CA Zip; 95112 b. D Substituted Service: I personally gave copies of the documents checked in© (a, b, or d) to {check one): D A competent adult (at least 18) at the home of, and living with the person in® , or 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 no known physical address for the person in®. Itold that adult, "Please give these court papers to (name 0f person in©." Idid this on (date): At (time): D am. D p.m. At this address: City: State: Zip: Name or description ofthe person I gave the papers to: Afier serving the court papers, I put copies of the documents listed in® in an envelope, sealed the envelope, and put first-class prepaid postage on it. I addressed the envelope to the person in (D at the address where I left the ccpies. I mailed the envelope on (date): fiom (city, state): by leaving it (check one): a D At a U.S. Postal Service mail drop, 0r b. D 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, or c.D With someone else I asked to mail the documents to the person in CD, and l have attached that person’s completed Form SC-IO4A. ® Server‘s Information Name; Faviola Fuentes Phone; (408) 277-6700 Address: c/o Court Services Unlimited,255 North Market Street, Suite 130 Cityisan Jose State:CA Zip:95110 Fee for service: $ 125 . 00 r Ifyou are a registeredprocess server: County ofregistration: santa Clara Registration number: 1 7 0 7 ® I declare under penalty ofpexjury 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: 4/15/2021 *7 . Faviola Fuentes, SCCRPS#1707 ’W @fi Type 0rprint server 's name Server signs here afiE? serving Revised Januarytm proof of Service CEB SC-1 04. Page 2 of2 (Small Claims) ww.ceb.com
