Proof of Service SubstitutedCal. Super. - 6th Dist.April 10, 2020SC-1 04 Proof of Service Use this form to ser_ve a person, business, or a ublic entity. To learn more about proof of serwce, read What is _"Proofof _ervz'ce”?, Form SC-104B. To learn more about how to serve a bus1ness or entlty, read How to Serve a Business 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) or general partner (for a limited partnership) ' Any officer or general manager (corporation or association) ' Any person authprizpdfor service by the business (corporation, association, general .partnerhlp, 11m1ted partnershlp) ' Any per_son a_uthorizgd fo_r service with the Segregary qf State (corporation, assomatlprg, 11m1ted 11abi11ty company [LLC], 11m1ted 11ab111ty partnershlp ' [LLP], 11m1ted partnershlp) To serve a public entity', you must first file a claim with that entity, then serve one of the followmg people: ' Clerk (of a city or county) ° Chief officer or director (of a public‘agency) ° Any person authorized for service by the entity ® a. Ifyou are serving a person, write the person's name below: b. If you_arei serving a business, or entity,_write the name of the_ business or entlty, the person authorlzed for serv1ce, and that person's Job t1t1e: Advance Chiropractic Familv Care - Sharon Barqhi D.C. Business or Agency Name Aqent: Sharon Barqhi. D.C. /Authorized To Accept Person Authorized for Service Job Title ® Instructions to Server: Clerk stamps date here when form is filed. ml? c? Seiarlé'a CfaraWW ll Superior Court Santa Clara County, California Small Claims 191 N. 1st St San Jose, California 951 13 Case Number: 20 SC 083135 Case Name: Oliverez vs. Advance Chiropratic Family Care Hea'ring Date: 7/8/2020 Time: 8:30 am |Dept: M 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 inG) , 0r - Give a copy of all the documents checked in© to one of the following people: a. A competent adult (at least 18) living with, and at the home of the person in® , or b. An adult (at least 18) who seems to be in charge at the usual workplace of the person inG) , 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 ofthe documents left with one 0f 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 to serve these court papers in timefor theform to befiled wzth the court at least 5 days before the hearing. a. E SC-100, Plainnfi's Claim and ORDER to Go to Small Claims Court b. D SC-120, Defendant’s Claim and ORDER to Go to Small Claims Court | served the person in® a copy of the documents checked below: c. D Order for examination, (Thisform must be personally sefved. Check theform that was served): Note: The court can issue a civil arrest warrant ifthe servedparty does not come to court only z'fthe orderfor examination was personally served by a registeredprocess server, sherzfl marshal, or someone appointed by the court. (1)D SC-134, Application and Order to Produce Statement ofAssets and to Appearfor Examination (2)D AT-138/EJ-125, Application and Orderfor Appearance and Examination V d. Other, (specz‘fiz): Attached Declaration Judicial Council of California Revised January 1, 2009, Opu‘onal Forni Code of Civil Procedure 116.340, 41 5.10, 415.20 Proof of Service (Small Claims) SC-1 04. Page 1 of2 Job Number COP-2020004535 Case Number: 20 SC 083135 Case name: Oliverez vs. Advance Chiropratic Family Care ® Fill out "a" or "b" below: a. D Personal Service: Ipersonally gave copies ofthe documents checked in© to the person in®z On (date): At (time): At this address: City: ‘ State: Zip: b. Substituted Service: Ipersonally gave copies ofthe documents checked in© (a, b, d) to (check one): D A competent adult (at least 18) at the home of, and living with the person in® , or E 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 give these court papers to (name of person in® )." Idid this on (date): 05/27/2020 At (time): 11:28 AM At this address: 1102 'Scott Blvd Cityz. Santa Clara State: CA Zip: 95050 Name or description ofthe person I gave the papers to: Jennifer Doe (refused last name) / Apparently in Charge Ale: 50, Sex: f, Race/Skin Color: M.E., Heigm: 5', Weifl 140, Hair: black, Glasses: n After seriling 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 to the person in© ‘at the address where I lefi the copies. Imailed the envelope on (date): 05/28/2020 from (city, state): San Jose CA by leaving it (check one): a. D At a U.S. Postal Service mail drop, or b. At an office or business mail drop where I know the mail is picked up every day and deposited with the U.S. Postal Service, or c. D 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: Kenny Alfa'ro Phone: (408) 297-6070 Address: 31 E. Julian Street City: San Jose State: CA Zip: 951 12 Fee forservice: $ 60.00 County ofregistration: Santa Clara Registration Number: PS1675 © 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 the information above is true and correct. ( Date: 5 / l a lw Kenny Alfaro ’Z/ Type or print server’s name Sgrver signs here after serving $1?§:Lfi;::°:g°§,°;sfis,mg:mFm Proof of Service , 30-104: Pagan” Code ofle Procedure 116.340, 415.10, 415.20 Job Number COP_2020004535 (Small Claims)