Proof of Service SubstitutedCal. Super. - 6th Dist.March 16, 20205C4 04 Proof of Service Use this form to serve a person. a business. or a public entlty. To leam more about proof of service, read Whatis "ProofofServlce?", Form SC-104B‘ To learn more about how to serve a business or entity, read How to Serve a Business or Public Entity, Form SC-1 04C. To serve a business, you must serve one of the following people: Owner (for a sole proprietorship) Partner (for a partnership) or general partner (for a limited partnership) Any officer 0r general manager (corporation or association) Any person authorized for service by the business (corporation, association. general partnership, limited partnership) Any person authorized for service with the Secretary ofState (corporation, association. limited liability company [LLC], limited liability partnership [LLP]. limited partnership) To serve a public entity,you must first file a claim wlth that entity. then serve one ofthe following peeple: Clerk (ofa city or county) Chief officer or director (of a publlc agency) I Any person authorized for service by the entity a. rf you are serving a person. write the person’s name below: CARLOS FRAN CISCO CALLESRIVERA Clerk stamps date here when form is filed. Fill in court namea d‘stremdfi ' ' ‘m Superior Court of Califomrat'céflkty of Santa Clara 191 N 1st St SanJose. CA951 13 b. lfyou are serving a business or entity,wrh;e the name ofthe business or entity, the person authorized for service, and that person’s job title: Fm in case number, case name. hearlng date. day, tlme. and department below: Case Number. ZOSCOBZQST Business or Agency Name PersonAuthorized for Service Job Title ® Instructions to Server: You must be at least 18 years old and not be named In this case. Follow these steps: a Give a copy ofail the documents checked En to the person 1n G, or o Give a copy ofall the documents checked En to one of the following people: a. A competent adult (at least 18) [Jving with, and at the home of the person in® or Case Name: BRANDON REED vs. CARLOS FRANCISCO CALLESRJVERA Hearing Date: 06/1 5/20 Time: Dept: b. An adult (at least 18) who seems to be in charge at the usual workplace ofthe person in® or c. An adult (at least 18) who seems to be in ch35 where the person in® usually receives mail (but not a U.S. Post Office box), ffthere is no known physical address for the person in and mail a copy of the documents left with one ofthe adults in a, b. or c above to the person in® THEN o Complete and sig‘l this fem, and o lee or mail your completed form to the person who asked you to serve these court papers. In timefar theform to befiled with the court at least 5 days before the hearing. | served the person in® a copy of the documents checked below: a. SC-100, Plaintifis Claim and ORDER ro Go ro Smail Claims Coun b. D $0120. Defendant’s Claim and ORDER ro Go m Smal! Claims Cour: c. D Order for examination (Thlsform must be personally served. Check the form that was served): Note: The court can Issue a civil arrest warrant ifthe served pony does not come to court only ifthe orderfor examination was personally sewed by a registered process server, sherlfi‘, marshal, or someone appointed by the court (1) E SC-l 34, Application and Order to Produce Statement ofAsses and to Appearfor Examination (2) E AT-l 38/EJ-1 25, Application and OrderforAppearance and Examination d. m Other (specifi'): NOTICE TO LITIGANTS: REQUEST TO PARTICIPATE 1N ON-LINE DISPUTE RESOLUTION (ODR) FOR SMALL CLAIMS UTIGANTS judicial Council of California. vwvw‘cmm'nfomgov PROOF 0F SERVICE Revisedjanuar'y 1. 2009, Optional Form (SMALL CLAIMS) Code ofCiviI Procedure, §§ 116340.415‘10, 41520 SC-104, Page 1 of2 Case Number. Case Name: BRANDON REED Vs. CARLOS FRANCISCO CALLESRIVERA 2050382951 ® Fill out "a" or "b" below: a. D Personal Service: l personally gave copies ofthe decuments checked in® to the person in ®: O n (date): At (tim e): At this address: Ci ty‘. Sta te: Zi p: b. Substituted Service: | personally gave copies ofthe documents checked in® (a, b, or d) to (check one):E A competent adult (at least 18) at the home of. and Jivlng wlth the person In ®. orE An adult who seems to be in charge where the person in 8 usually works, or An adult who seems to be In charge where the person in usually receives mail, or has a pn’vate post office box (not a U.S Post Office box), ifthere Is no known physical address for the person in . [told that adult, "Please give these court pa pers to (name of person in ®)' | did this on (date): Mon, Apr 27 2020 At (time): 05:04 PM At this address: 1324 S Winchester Blvd apt # 1 19 City Sanjose State: CA 21p: 951 28 Name or description ofthe person I gave the papers to: JANE DOE-DEFENDANTS MOTHER REFUSED NAME-LIVES THERE ON OCCASION BUT RECEIVES MAIL (H.F.60. 5'7, 120 LBS, GRAYING BLACK HAJR) After serving the court pa pers,i put copies of the documents listed in® in an envelope. sealed the envelope. and put first-class prepaid postage on it. I addressed the envelope to the person in® at the address where I left the copies. | mailed the envelope on (date): 04/28/2020 from (city, state): SAN JOSE. CA by leaving it (check one): a. At a U.S. Postal Service mail drop, or b. E At an office or business mall drop where | know the mail is picked up every dayand deposited with the U.S‘ Postal Service. or c. E With someone else l asked to mail the documents to the person in (D, and I have attached that person's comp1eted Form SC- 104A. ® Server's Information Name: HECTOR TORRES @ LEGAL PURSUIT INC Phone: 408-28841 05 Address: 22 W. St. John Street # B City. SAN JOSE State: CA Zip: 951 13 Fee for service: $ nyou are a registered pro cess server: County of registration: SANTA CLARA Registratlon number: 1585 ® [declare under penalty of perjury under California state law that I am at [east 18 years old and not named in this case and that the information above is true and correct. Data: 04/29/20 HEGOR TORRES w Type or print server's name Server signs here after serving Revlsedjanuary 1,2009 PROOF OF SERWCE SC-104, Pagezofz (SMALL CLAIMS)
