Proof of Service PersonalCal. Super. - 6th Dist.March 11, 2020'I . Clerk S(amps dare here when form is filed. $0.1 04 Proof of Serwce -. . 1. 3%.". Use this form t0 serve a person, a business, or a public entity. To learn more about proof of service, read W710! Is ’T’roofofService"?, Form SC-104B. To learn more about how t0 serve a business 0r entity, read How t0 Serve a Bminess 0r Public Entity, Form SC-104C. To serve a business, you must serve one ofthe following people: ° Owner (for a sole proprietorship) ' Partner (for a partnership) 0r general partner (for a limited partnership) o Any officer or general manager (corporation or association) ° Any person authorized for service by the business (corporation, association, general partnership, liInjted partnership) Fill in coun‘ name and street address: ~ Any person authorized for service with the Secretary 0f State (corporation, SUF’emr 0mm °f ca'ifomiav C°Unty 0f association, limited liability company [LLC], limited liability partnership Superior Coufi-Civil Division [LLP], limited partnership) d- 191 N. First St. T0 serve a public entity, you must first file a claim with that entity, then San Josel CA 95113 serve one 0fthe following people: - Clerk (0f a city 0r county) I - Chief officer 0r director (0f a public agency) Si” i” .0339 ”2'73“: 0339 name, .hean‘ng dare. ‘ Any person authorized for service by the entity ay‘ “me' an apartment beiow' ® a. I yo are servigg person,wn'te th§perso ’s namebelow: case Numbenza 5006;”) films a gr dc, m’- . . . . C N : ‘ § b. If you are servmg a business or entlty, wnte the name 0f the busmess age ame 54mg bl A/éflJa/VA 0r entity, the person authorized for service, and that person’s job title: Business orAgeucy Name Hearing Date: // /9 /202& Person Authorized for Service Job Title Time: /:00 PM Dept;® Instructions to Server: You must be at least 18 years 01d and not be named in this case. Follow these steps: ° Give a c0py of all the documents checked in® to the person in®, or ° Give a copy 0f all the documents checked in® to one 0f the following people: a. A competent adult (at least l8) living with, and at the home of the person in ®, 0r b. An adult (at least 18) who seems to be in charge at the usual workplace of the person in ®, 0r 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 n0 known physical address for the person i116). and mail a copy of the documents left with one 0f the adults in a, b, or c above to 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 cburt papers, in timefor theform t0 befiled with the court at least 5 days before the hearing. ® [served the person in CD a copy of the documents checked below: ( i O a. [VSC-IOO, Plainnfl's Claim and ORDER to Go r0 Small Claims Court b. D SC-120, Defendant’s Claim and ORDER t0 G0 t0 Small Claims Court c. D Order for examination (Thisform must be personally served. Check theform that was served): Note: The coart can issue a civil arrest warrant zfthe servedparty does not come t0 court only zfthe orderfor aramination was pemonally served by’ a registeredprocess server, shenfi: marshal, 0r someone appoitzied by the c0101. (1) D SC-134," Application and Order t0 Produce Statement ofAssets and t0 Appearfor Exgmination (2) D AT- 1 38/EJ-125, Application and Orderfor Appearance and Examination d. D Other (specifi): Judauamounm otoamomja. www.mm‘nfoagov Proof of Service SC-104, Page 1 $2Revised January 1. 2009. Optional Form I CodeofcwnProcedure.§§116,340.415‘1041520 (Small Claims) Case Number: Case name: ®aFill ou “”a or “b” below: Personal Service: I personally gave cepies of the documents checked 1n® t0 the person in®z On (date).m At (mm)- E/m B p.m. Atthis address: /0#§ CDmWQ/“CJ@L ff tygfil/l‘ Jflgg State C/A Zip 9f//Z b. D Substituted Service: Ipersonally gave copies of the documents checked 'm© (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® usually works, or. D An adult who seems to be in charge where the person in® usually receives mail, 0r has a private post office box (not a U.S. Post Office box), if there is no known physical address for the person in® ItoId that adult, "Please give these court papers to (name of person i116)" Idid this on (date): At (time): D am. D p.111. At t.his.address: City: V State: Zip: ' Name .or descrifjtion of the person I gave the papers to: After serving the court papers, I put copies of the documents listed in© in an envelope, sealed the envelope, and pup first-class prepaid postage on it. I addressed the envelope to the person in at the address where I lefi the copies. I mailed théenvelop'e 0n (date): fi'om (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 ls picked up every day and deposited with the U. S. Postal Service, or (LE 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: J0$6 I @A0NA Phone: 93 /"}9‘27%735‘ Address- Hm HEQBM MKS 0r City gal?M GA/Lj'7 State: M Zipim Fee for service: $ ;&_- [fyou are a registeredprocess server: County of registration: Registration number: " ® I declare under penalty of perjury under California state law that I am at least 18 years 01d and not named in this case and that he ' ormation above is true and correct. Date:m _ flJ95? / A0w b W m Type orprint server ’s name Server signsfléI e afler sewing Revised January 1.2009 proof of Service 80-104, Page 2 of2 (Small Claims)
