Proof of Service SubstitutedCal. Super. - 6th Dist.March 5, 2020_ Clerk stamps date here when form is flied.SC-1 04 Proof of SerVIce Use this form to serve a person, a business, or a public entity. To learn about proof 0f service, read What Is ’TroofofSeWice"?, Form SC-104B. " learn more about how to serve a business or entity, read How r0 Serve a Business 0r Public Entity, Form SC-104C. T0 serve a business, you must serve one of the following people: - Owuer (for a sole proprietorship) - Partner (for a partnership) or general partner (for a limited partnership) Supfi - Any officer or general manager (corporation or association) BY - Any person authorized for service by the business (corporation, association, general partnership, limited partnership) FIN in court name and street address: - Any person authon'zed for service with the Secretary of State (corporation, SUPerior court °f california’ county Of association} limited liabifity company [LLC], limited liability partnership superior Court-CjVi] Division [LLP], hmlted partnershlp) 191 N. First St To serve a public entity, you must first file a Claim with that entity, then San Jose] CA 95113 serve one of the following peeple: - Clerk (0f a city or county) . Chief officer or director (Of a public agency) Fifi in 40659 number, case name, hearing date, - Any person authorized for service by the entity day’ flme' and department below Case Number: a. If ou are servinoa erson, ‘te the erson’s name belowz.® y «a 0A “23mm wéwmw Case Name: b. Ifyou are serving a bukskess or enfiAI, write the name ofthe business or entity, the person authorized for service, and that person’s job title: l l Business orAgency Name Heanng Date:m /08/Q_O;10 Person Authorized for Service Job Title Time: Q: gaA \Dept; [E S® Instructions to Server: You must be at least 18 years old and not be named in this case. Follow these steps: ° Give a copy 0f all the documents checked in® to the person in G), 0r - Give a copy 0f all the documents checked in® t0 one of the following people: a. A competent adult (at least 18) living with, and at the home 0f the person in (D, 0r b. An adult (at least 18) who seems to be in charge at the usual workplace of the person in G), 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), if there is no known physical address for the person in©. and mail a copy of 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 asked you t0 serve these court papers, in timefor theform t0 befiled with the court at least 5 days before the hearing. ® lse d the person in (D a copy of the documents checked below: fl E (-1 a. SC-IOO, Plaintifs Claim and ORDER t0 G0 t0 Small Claims Court b. D SC-120, Defendant’s Claim and ORDER t0 G0 t0 Small Claims Court c. D Order for examinati0n (Misform must be pensonally served. Check theform that was served): Note: The court can issue a civil arrest warrant zfthe servedparty doe: not come t0 court only ifthe orderfor aramination was personally served by a registeredprocess server, shenfi marshal, orsomeone appointed by the court. (1) D SC-l34, Application and Order t0 Produce Statement ofAssets and t0 Appearfbr Examination (2) El AT-l 38/EJ-125, Application and Orderfor Appearance and Examination d. D Other (specz'fix): JudIFialCoundloVCafifonfia. w.wurfinfo.ca.gov Proof of service SC.1 04’ Page 1 of2 Rewsed January 1. 2009. Opunnal Form _ a Code omivu procedure. §§ 116.340. 415.10. 41520 (Small Claims) Case Number: Case name: @aFill out “a” or “b” below:D Personal Semce: Ipersonally gave copies of the documents checked 1n® to the person in®. On (date):--- At (time):-- D am. me. At this address: Clty State Z1p b. é sgsfituted Service: Ipersonally gave copies 0f the documents checked in© (a, b, 0r d) t0 (check one): ' 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 ve these court papers to (name ofperson i116)" Idid this on (dare) 9%; OF] MW At (time): U00 D am. BK At this address: 736 33R Cd“‘N\\D\\Q/ rm? ley Cm“ 3W1 State: 64R ZR OVBTQ7 Name or description 0f the person I gave the papers to: \)Q\\% ‘(m‘MW After serving the court papers, I put copies of the documents listed in C3) 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 copies. I mailed the envelope 0n (date): from (city, state): by 1e ving it (check one): At a U.S. Postal Service mail drop, or b. D At an office 0r business mail drop where Iknow the mail is picked up every day and deposited with the U.S. Postal Service, or (LU With 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: “\wfi T\\\, whwwq Phone: tk$ ' 8M a 66%g Address: ”€55 \WAM \F. City: Wyn K066, Q State: a Zip: a 5 J Ltg Fee for service: $ Ifyou are a registeredprocess server: county Ofl‘egisuatiom Registration number: ® I declare under penalty of pexjury 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:MM » Whom (wmgmm ?fix® Type orpriMserver s name ServeWhey-eMfg,. . ng Revised January 1.2009 proof of Service 50-104, Page 2 of2 (Small Claims)
