Proof of Service PersonalCal. Super. - 6th Dist.March 2, 2020{*7 Y4 SC-1 04 Proof of Service Use this form to serve a person, a business, 01’a public entity. To learn more about proof of service, read What Is "ProofofService"?, Form SC-l 04B. To learn more about how t0 serve a business 0r entity, read How t0 Serve a Business or Public Entity, Form SC-104C. T0 serve a business, you must serve one ofthe following people: - Owner (for a sole proprietorship) ° Partner (for a partnership) or 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, limited partnership) ° Any person authorized for service with the Secretary of 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 serve one ofthe following peeple: ° Clerk (of a city or county) - Chiefofi‘icer or director (0f a public agency) - Any person authorized for service by the entity ® a. Ifyou are serving a person, write the person’s name below: Keith Nguyen b. Ifyou are serving a business or entity, write the name ofthe business 0r entity, the person authorized for service, and that person’s job title: Business or Agency Name Person Authorized for Service ® Instructions to Server: Job Title Clerk stamps date here when form is filed, .eumy oi santa Clara DEFU‘I’Y Dinhnirr‘n 1 Fill in court nar‘figaufiansiréet‘address.' Superior Court of California, County of Santa Clara, Superior Court Civil Division 191 N. First St. San Jose, Ca 951 13 Fill in case number, case name, hean’ng date, day, time, and department below: Case Number: 208C082793 Case Name: Po-Jen Lin vs Keith Nguyen Hearing Date: 04/07/20 Time: 8:30am Dept: 14 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, 0r - Give a copy ofall the documents checked in® to one of the following people: a. A competent adult (at least 18) living with, and at the home 0fthe person in , or b. An adult (at least 18) who seems t0 be in charge at the usual workplace ofthe person in CD, or c. An adult (at least 18) who seems to be in charge where the person in©usually receives mail (but not a U.S. Post Office box), if there is no known physical address for the person in®. and mail a copy 0f the documents left with one of the adults in a, b, 0r c above to the person in® THEN - Complete and sign this form, and - Give or mail your completed form to the person who §§ked_ ygu to serve these court papers, in timefor theform ta beflled with the court at least 5 days before the hearing. © lserved the person in ® a copy of the documents checked below: a. SC-IOO, Plainnfs Claim and ORDER t0 Go t0 Small Claims Court b. D SC-120, Defendant’s Claim and ORDER to G0 to Small Claims Court w C. D Order for examination (Yhisform must be personally served. Check theform that was served): Note: The court can issue a civil arrest warran! IfIhe servedparly does no! come lo court only {fthe orderfor examination was personally served by a registeredprocess server, sherifl: marshal, 0r someone appointed by the caurt. (1) D SC-134, Application and Order to Produce Statement ofAssets and t0 Appearfbr Examination (2) D AT-l38/EJ-I 25, Application and Orderfor Appearance and Examination d. El Other (specxfy): Judiu‘aj Couna'l of California. W.wum'nfolm.gov Revised January 1, 2009. Optional Forrn Code afCivil Procedure. §§ 116.340. 415.10. 415.20 Proof of Service (Small Claims) SC-104, Page 1 of29 '\\ Case Number: 208C082793 Case name; Po-Jen Lin vs Keith Nguyen ® Fin out “a" or “b" below: a. Personal Service: I personally gave copies of the documents checked in® to the person in©: On (date): ---3/6/2020 At (time): __-2354 D am. p.m. At this address: 601 Saratoga Ave. City: San Jose State. CA Zip: 95129 b. D Substituted Service: Ipersonally 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®. I told that adult, "Please give these court papers t0 (name of person in©." I did this 0n (date): At (time): D a.m. U pm. At this address: City: State: Zip: Name or description ofthe p'erson I gave the papers to: After serving the court papers, I put copies 0f 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® at the address where I lefi the copies. I mailed the envelope on (date): fiom (city, state): by leaving it (check one): a. D At a U.S. Postal Service mail drop, or b. U 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 QB With someone else I asked to mail the documents to the person in (D, and I have attached that person’s completed Form SC-104A. ® Server’s Information . Name: Queenie Orteza Phone: 403-475-4494 Address: 3368 Methilhaven Lane City: San Jose _ State: C3 Zip: 95121 Fee for service: $ 55 Ifyou are a registeredprocess server: County Ofregisttation: santa Clara Registration number; PSl672 ® l declaxe under penalty 0f perjury under California state law that I am at least 18 yeam old and not named in this case and that the information above is true and correct. Date: 3/07/2020 Queenie Orteza ’ Tye orprfm‘ server ’s name , Server signs here afier serving Revised January 1. 2009 Proof of Service 50-1 o4, Page 2 01 2 (Small Claims)