Proof of Service PersonalCal. Super. - 6th Dist.March 10, 2020Clerk stamps date here when form is fired Proof of Service Use this form to serve a person, a business, or a public entity. To leam more a i E D about proof of service, read What Is "ProofofService"?, Form SC-104B. T0 learn more about how t0 serve a business or entity, read How to Serve a Business 0r Public Entity, Form SC-104C. NOV 0 ZU To serve a business, you must serve one of the following people: CI - Owner (fqr a sole proprietorship) Supenor Amg‘gosgg Clara ' Partner (for a partnership) 0r general partner (for a limited partnership) BY ‘ DEPUTY t Any officer or general manager (corporation or association) ' pl ?EFHO Fill in court name and street address: Superior Court of California, County of V , _ . Santa Cl‘lara ° Any person authonzed for serv1ce w1th the Secretary of State (corporatlon, 191 N First St association, limited liability company [LLC], limited liability partnership San Jose CA 95] 13 [LLP], limited partnership) To serve a public entity, you must first file a claim with that entity, then ° Any person authorized for service by the business (corporation, association, general partnership, limited partnership) serve one Ohhe fOHOWing peOple: Frh‘m case number, case name. heanng dare, ° Clerk (0f a city or county) day, time, and depadmentberow: ° Chief officer or director (of a public agency) gggzzgg‘be“ ° Any person authorized for service by the entity 873 - Case Name: a. Ifyou are serving a person, write the person’s name below: Mario Cesar Hernandez Arzate b. If you are sewing a business or entity, write the name ofthe business Hearing Date: December 9 2020 or entity, the person authorized for service, and that person’s job title: ’ Time: 8:30am Dept: 15 Business or Agency Name Person Authorized for Service Job Title ® Instructions to Server: You must be at least 18 years 01d and not be named in this case. Follow these steps: ° Give a copy of all the documents checked in® t0 the person in CD, 0r ° Give a copy of all the documents checked in© t0 one of the following people: a. A competent adult (at least 18) living with, and at the home of the person in Cl) , 0r b. An adult (at least 18) who seems to be in charge at the usual workplace ofthe person in (D , 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 ofthe documents left with one ofthe adults in a, b, or c above to the person in® THEN ° Complete and sign this form, and o Give or mail your completed form to the person who asked you to serve these court papers, in timefor theform r0 befiled with the court at least 5 days before the hearing. iserved the person in (D a copy of the documents checked below: O a. E SC-lOO, Plaintifl’s Claim and ORDER (0 Go t0 Small Claims Court [ ) b. D SC-IZO, Defendant’s Claim and ORDER to G0 t0 Small Claims Court c. D Order for examination (This form must be personally served. Check the form that was served): Note: The court can issue a civil arrest warrant ifthe served party does not come to court only ifthe order for examination was personally served by a registered process server, sherifi', marshal, or semeone appointed by the court. (1) D SC- I 34, Application and Order t0 Produce Statement ofAssets and 10 Appearfor Examination (2) D AT-l 3 8/EJ- 1 25, Application ana’ Orderfor Appearance and Examination d. D Other (specifiz): J djclalCo ncilof Cafifom' . . r1 . . I Rueul January 1,2009. Opulgnmngou scagov PrOOf 0f service 5C4 04: Page 1 0f 2 Coda ofcwil Procedure. §§ 116.340. 415.10. 415.20 (Small Claims) “.- '1 Case Number: Case Name: 208C082873 ® Fill out “a” or “b" below: a. Personal Service: I personally gave copies 0f the documents checked in © to the person in® on (date): November 26, 2020 At (time): 10:15 E am. D p.m. At this address: 118 Nancy Ln APT #2 City: San Jose State: CA Zip: 95127 b. D Substituted Service: I personally gave COpies ofthe documents checked in ® (a, b, 0r 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 (D usually works, 0r 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 G) [told that adult, "Please give these court papers to (name ofperson in ®). I did this on (date): At (time): D a.m. D p.111. At this address: City: State: Zip: Name or description of the person I gave the papers to: Afier serving the court papers, I put copies ofthe documents listed in® in an envelope, sealed the envelope, and put first-class prepaid postage on it. I addressed the envelope t0 the person in @at the address where I lefi the copies. I mailed the envelope on (date): from (city, state): by leaving it (check one): a. D At a U.S. Postal Service mail drop, or b. D At an office 0r business mail drop where I know the mail is picked up every day and deposited with the U.S. Postal Service, 0r c. D With someone else I asked to mail the documents to the person in® , andI have attached that person’ s completed Form SC-104A. ® Server’s Information ® Name: Alex Melnik Phone: 408 416 7799 Address (zflmown): 410 E Santa Clara St #1 03 City: San Jose State: CA Zip: 951 13 Fee for service: $ 90.64 Ifyou are a registeredprocess server: County of registration: Santa Clara Registration number: 1714 I I declare under penalty ofperjmy 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: November 27, 2020 Alex Melnik > a KM Type or print server’s name Server signs‘fzere szték serving ReviseaJanuary 1. 2009 Proof of Service sc-1o4, Page 2 of 2 (Small Claims
