Proof of Service SubstitutedCal. Super. - 6th Dist.March 5, 2020Santa Clara - Civil SC - 1 04 Proof of Service Clerk stamps dare here whenform rsfifed. Use this form to serve a person, business, or public entity. To learn more about proof of service, read What Is Proof of Service?, Form SC-1 04B, To learn more E|ectronica||y FiIed about how to serve a business or public entity, read How to Serve a - Business,Form SC-104C, . by SUperlor court Of CA’ To serve a b ' o must serve ofthe follo ing people county Of santa Clara’ usmess, y 11 ' one w : _ OOwner (for a sole proprietorship 0r a business, form unknown) on 1_0/21 [2020 2 '33_PM _ OPanner (for a partnership) or genera] pariner (for a limited pannership) Rewewed By: D- Pln hel r0 OAny officer or general manager (corporation or association) Case #203C082842 OAny person authorized for service by the business (corporation, association, Envelope: 51 52436 General pannershjp, limited partnership) .Any person authorized for service with the Secretary 0f State (corporation, association, limited-liability company (LLC), limited-liability pannership (LLP), linnted parmersmp) SANTA CLARA T0 serve a public entity,you must first file a claim with that enfity, then 191 N' FIRST ST' serve one of the following people: SAN JOSE’ CA 951 13 .Clerk (0f a city 0r county) o Chief officer or director (of a public agency) o Any person authorized for service by tl’w entity. Fill in case number, case name. hearing date, day, time, and department below: a. Ifyou are serving a person, write the person's name below: Case Number: zoscoszuzB b. Ifyou are serving a business or pub lic entity, write the name of the Case Name: business or entity, the person authorized for service, and that person's THE FORD STORE MORGAN HILL vs. job title: SOUTH COUNTY COLLISION CENTER Business or Agency Nam Hearing Date: 1012019020 Person Authorized tor Service - Job Title Timgiao AM Depylh ® 208C082842 Fifi fr: court name and3m e! adfiwss; Superior Court of California, County of Instructions to Server You must be at least 18 yeals old and not he amed in this case. Follow these steps: o Give a copy of the documents checked in é“) the person in , 0r . Give a copy 0f the documents checked in ®to: a. A competent adult (at least 18) at the home of and living with the person in ®or b. An adult (at least 18) who seems to be in charge or c. A11 adult (at least 18) who seems to be in charge at the place where the person receives mail (not a U.S. Postal Service P.O. Box), if there is n0 known physical address for the person in ®. and mail a copy 0f the documents left with one of the adults in a, b, or c above t0 the person in ® 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 the form t0 befiled with the court at least .5 days before the hearing. I SEGIVGG the person in (D a copy Of the documents CHECKBd bBIOW: O a. SC~100, Plaintiff‘s Claim and ORDER to Go to Small Claim Court E l : ) b.U 80-120, Defendants Claim and ORDER to Go to Small Clams Court c. D Order for Examination (Thisfomz must be personally served. Put a check mark next r0 theform that was served): Note: The court can issue a civil arrest warrant ifrhe servedparty does nor come t0 court but only ifrhe Order for Examination was persona”); served by a registeredprocess server, sherifi marshal, or someone appointed by the court. (1)D SC-134, Application and Order t0 Produce Statement ofAssets and t0 Appearfor Examination (2)D AT-138/EJ-125, Application and Orderfor Appearance and Examination d. mother (SpeClfi/fiNOTICE T0 SMALL CLAIMS LITIGANTS (SC-BOOS): REQUEST TO PARTICIPATE IN ON-LINE DISPUTE RESOLUTION (ODR) FOR SMALL CLAIMS LITIGANTS (36-8020) 36777 Judicial Councilof California. www.mwflnfo.ca.gov sc_alo“ Pa e 1 012 Revised January 1. 2009, Optional Form PROOF 0F SERVICE ' g Code orCiviI Procedure,§§ 116.340, 415.10, 415.20 (Small ClalmS) XVd A8 GH'IH Ca 5e Number: 208C082842 Case name: @ Fill out "a" or "b" below: an Persona] Service: Ipcrsonally gave copies of the documents checked in ®to thc person in®: On (date): At (time): At this address: City: State: Zip: hm Substituted Serviced personally gave copies of the documents checked in ® (a, b or d) to (check one): A competent adult (al least 18) at the home of. and living with the pegm in, or An adult (at least 18) who seems to be in charge where the person in usually works or An adult (at least 18) who seems to be in charge where the person in ® receives mail, 0r has a privat mailbox (not a U.S. Postal Service P.O. Box), if there is no known physical address for the person iné. I told that adult, "Please give these court papers to (name querson m ® ). I did this on (date):]_Qfl_9/2020 At (timez:2:55 PM At this address: 16540 RAILROAD AVENUE. SUITE 100 City/State/Zip: MORGAN HILL CA 95037 Name or description of the pemon I gave the papers to: ROGELIO ROMERO - MANAGER AGE: 50's HEIGHT: 5'-7' WEIGHT: 170 HAIR: BROWN RACE: HISPANIC EYES: BROWN After serving the court papers, Ipul copies of the docmncnts listed in ®in an envelope, sealed the envelope, and put first-class prepaid postage on it. l addressed the envelope to the person in ® at the address where I left the copies. I mailed the envelope on (date): 191191292Q from (city, state): SAN BRUNO CA CA by leavin it at (check one).- a. 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 CMWith someone else I asked to mail the documents to the person in ® , and I have attached that person's completed Form SC-104A. ® Server's Information Name: GARY GENEST Phone: (650) 794-1 923 Address: 901 Sneath Lane Suite 115 City: San Bruno. CA 94066 Fee for service: $ 85.00 (Ifyou are a registeredprocess server).- County of registration: SANTA CLARA Registration number: PS1 560 © I declare, under penalty of peljury under California State law, that I am at least 18 years old and not listed in this case and that the infonnation above is true and comet. Date: 1 0l1 91’2020 GARYGENEST ’ [QM (97% Type 0r print server's name Server signs here afier serving WWW“-m PROOF 0F SERVICE (Small Claims) SC-104.Page2of2 Ca 5e Number: SC'104A Proof of Mailing (Substituted Service) 2050082842 This form is attached to Form SC-104. Use this form ONLY ifyou mailed the documents in ® and someone clsc personally gave them to the person, business. or public entity served. Notice to Server You must: 0 Be at Ieas. 186d not listed in this lawsuit. 0 Fill out -- (D ® © of this form and attach it lo Form SC-104. Documents served by mail: a_ MSC-IOO, Plaintiffs Claim am! ORDER t0 Gr) r0 Small Claims Court b.D SC-lZU, Defindanr's Claim and ORDER m Go t0 Small Claims Court c, MOther(spchfiJ-‘flN-UNE DISPU Name and address of the person, business. or public entity sewed: a. Ifyou sewed a person, write the person's name and Name; SOUTH COUNTY COLLISION CENTERAddressfl Street City State Zip b_ If you served a business or public entity, write the name and address of the business or public entity, the person authorized for service, and that person's job title: Business or Public Entity Name Parson Aufl'lonzsd for Service Job Title Address: Street City State Zip Iput copies of the doonmcnts listed in ® abcwe in an envelope, sealed the envelope. and ut first-class prepaid postage on it. 1 addressed the envelope to the person, business, or public entity listed in and mailed the envelope by leaving it at (check one): a.D At a us. Postal Service mail drop, or b. MAJ an office or business mail drop where I know the mail is picked up every day and depasited with the U.S. Postal Sewice. I mailed the envelope: a. On (date): 19m 912929 b. From (city. state): SAN BRUNO. CA MY addressisrjfllfinsflhLmfiGB Ideclare. under penalty of perjury under California State law, that the information above is true and correct. DatEZJQUQIZO20 r”M w p f "2W”TONY VARGAS 1 "' Type or print server's name Server signghere afiermng (J éiffs‘gfigfljfiffi”Cg'ggffiétmgwmaw Proof of Mailing (Substituted Service) SC-104A. Page1 on Code or Ciml Procedure, §§1 16,340, 41 5,20 (Small Claims)
