Proof of Service PersonalCal. Super. - 6th Dist.March 9, 2020Clerk stamps date here whefi form is filed. SC-1 04 Proof of Service ~ : Use this form to serve a person, a business, or a public entity. To learn more- about proofof service, read Whatls "ProofofService”?, Form SC- 104B To leam more about how to serve a business or entity, read How to Serve a Business or Public Emily, Form SC- 104C. To serve a business, you must serve one of the following people: - Owner (fof‘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) > Ff” i" 00W name 8nd S‘me’ §§de55 ° Any person authorized for service with the Secrétary of State (corporation, SUperi” CW" °f calif°{nia' c°unty °f association, limited liability company [LLC], limited liability partnership Sm 7L“ C/Ara [LLP], limited partnership) Dawn fawn {urea}, (WM; To serve a public entity, you must first file a claim with that entity, then 4. Q1 Fir >+ 5 7L, serve one ofthe following people. 50,. :50; < , (A ”I 9 ’ ‘ 3 - Clerk (ofa city or county) I . Chief offiber or director (0f a public agency) V Fill In case number, case name, hearing date, ‘ . . . day, time, and depanmentbe/ow: I ‘ - Any person authonzed for serVIce by the entity Case Number. (D g. Ifyou'are serving a person, write the person’s name below: V Z O s C 0 3 Z 29% ' Degfifr Ferflfi/M/EL b. Ifyou are sewing a business or entity, wfite the néme ofthe business or entity, the person authorized for service, and that person’s job title: CaseName: Gran Rama 5:?! V, DeiJ-(r F Crn GA J‘L t _ Hearing Date: Busmess or Agency Name OH /1O/Z o Z 0 Person Authorized for Service Job Title 4 > Time: 2 : 7 0 GM Dept: i 5 Instructions to Server: You must be at least l8 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@, 0r . ‘ l I I D § - Give a copy of all the documents checked in© to one ofthe following people: a. A competent adult (at least l8) living with, and at the home ofthe person in ®, or b. An adult (at least 18) who seems to be m charge at the usual workplace ofthe person in ®, 0r 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), ifthere 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 ’ .i - Complete and sign this form, and ' ‘ 1 1 ‘ ' Give or mail your completed form to the person who asked you to serve these court papers in timefor theform to beflled with the court at least 5 days before the hearing. ’ ® I served the person in (D a copy of the documents checked below:‘ a. m SC- 100, Plaintifl's Claim and ORDER lo Go to Small Claims Court b. D SC-120, Defendant 's Claim and ORDER lq Go to Small Claims Court c. D Order for examination (Thisform must be personally served. Check theform that was servad): Note. The court can issue a civil arrest warrant iflhe servedparty does n0! come Io court only ifthé 01 derfor examination was personally served by a registered process server, shenfl" marshal, or someone appointed by the court. (1) D SC- 134, Application and Order to Produce Statement ofAssets and t0 Appearfor Examination (2) D AT-l3_8/EJ- 125, Application and Orderfor Appealance and Examination g , I l d. D Other (specifiz). . ) Juaidawound: otoaliromiamwmoaunlnlo‘cagav ' ' ' 'SC-1 04 Pa e 1 of 2 RamedJanuary1,2oog.0puonaIForm PrOOf Of se'rv'ce L ' g 9 Code atom Procedure. §§ 116340. “540,415.20 - (Small Claims) ___. __ ; ‘ 4 » n I Case Number: i a Casename: Gram Ramos V- DeHcr F(rrumh7 205(0323133 Q) Fin out "a" or “b" below. a a. E Personal Service: I personally gave copies ofthe documents checked m© to the personn O.n(date)M Atmme)M Baum Rpm :i Atthisaddress: 313 Aui/IIJQ Nonm/(S 7 .l . City; , 56m TOSC ‘ State; 69 IZip: qg/23 b. D Substituted Service. I personally gave copies ofthe documents checked 1n© (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 J j: D An adult who seems to be m charge where the person in® usually works, or ‘ D An adult who'seems to be'in charge wherethe person in®usually receives mail, or has a private post office box (not a U.S. Post Office box), ifthere is no known physical address for the person i I told that adult, "Please give these court papers to (name of person in 3 Idid this on (date): ‘ . ' At (time): ' mi a. m. D p.m. At this address: ' ' _ . ' ‘5 City: > . State: Zi'p{ 3’ Name or description of the person I gave the papers to: After serving the court papers, I put copies of the documents listed in© in an envelope, sealqd the envelope, and put flrst-class prepaid postage on it. l addressed the envelope to the person in at the address where I lefl the copies. 9 1 I mailed the envelope on (date): from (city, state): ' by leaving it (check one). I ~ I '- . l; 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 ls picked up every day and degosited with the U S. Postal Service, or c D With someone else I asked to mail the documents to the person in G), and I have attached that person ’s completed Form SC- 104A - G) Server’slnformationr _- , _..., Name3 I Kffan A/Maum Phone: (0/ 03) 201 2172, Address: ’5 Z ‘fi “I VarX/m/M 0,-_ . I CW3 San 3 05 C ' _ .» ' State: C ’9 Zip: i? g /3 Z. > Fee for service: $. Z 0- U0 V ’ I ' ' i! ' . Ifyou are a registered prbcess serve}: l ‘ ‘ county 0f TegiStTationi ‘ ‘ Registration number: l =_._‘ _.._. ® I declare under penalty of perjury under California state law that I am at least l8 years old and not amed in this case and that the infomation above Is true and correct Date:m° Erlfin walm A ’ EX/flw Type or print server ’s name " ' Server signs here afté/serving " I : | t . Revised Janu’ary 1.2009 I Proof Of Service v , _ ' $C--104 Page 2 of2 (Small Claims) . 1
