Proof of Service SubstitutedCal. Super. - 6th Dist.March 2, 2020i \V ,vu‘§ /, SC-1 04 Proof of#Service Use this form to serve a person, a business, or a public entity. To learn more about proof of service, read What Is ’TroofofService"?, Form SC-104B. T0 lcam more about how to serve a business or entity, read How t0 Serve a Business 0r Public Entity, Form SC-104C. To serve a business, you must serve one of the following people: I Owner (for a sole proprietorship) ' Partner (for a partnership) or general partner (for a limited partncrship) I Any officer or general manager (corporation or association) ' Any person authorized for service by the business (corporation, association, general partnership, limited partnership) I Any person authorized for service with the Secretary of State (corporation, association, limited liability company [LLC], limited liability partnership [LLP], limited partnership) To serve a public entity, you must first file a claim with that entity, then serve one of the following people: I Clcrk (of a city 0r county) ' Chief officer or director (of a public agency) I Any person authorized for service by the entity a. Ifyou are s rving a person, 'te the person’s name below: AN ' \ "k WI j b. Ifyou are serving a businegs or entity, write the name ofthe business or entity, the person authorized for service, and that person’s job title: Business or Agency Name Person Authorized for Service Job Title ® Instructions to Sewer: K" /’ Clerk stamps date hem when form is filed. ‘e Court {unly DJ Sarita Clara - ' . r E UT? -Bav1tl’F-‘?n .exro 1f ti?“ h Fill in court name and sMet address: Superior Court of California, County of 51k]- ?em‘g-F C9 d(sj/ L4 M fl strszw i cu {UL (LL 5g, fiw/ file Q 9ft: 3 F171 In case number, case name, hearing daTe, day, time, and department below: Case Number: iegoggg 3 Q0 Case Name: Hearing Date: a d @g f LO Dept? L_fTime: ‘ \' 0,0 PM l You must be at least 18 years old and not‘be named in this case. Follow these steps: I Give a copy of all the documents checked in® to the person in@, 0" ' Give a copy 0f 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 © , 0r b. An adult (at least l8) who seems to be in charge at the usual workplace of the person in ® , 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 of the adults in a, b, or c above to the person in CD . THEN I Complete and sign this form, and I Give or mail your completed fonn to the person who asked you t0 serve these court papers, in timefor theform t0 befiled with the court at least 5 days before the hearing. ® lserved the person in G) a copy of the documents checked below: a. SC-100, Plaintifl’s Claim and ORDER t0 G0 to Small Claims Court b. D SC-120, Defendant’s Claim and ORDER to Go 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 if the order for examination was personally served by a registered process server, sheriff, marshal, or someone appointed by the court. (1) U SC-134, Application and Order t0 Produce Statement ofAssets and to Appearfor Examination (2) D AT-138/EJ-125, Application and Orderfor Appearance and Examination d. D Other (specifiz): Judicial Council of California, www.oourts.agov Rev. January 1, 2009, Optional Form Proof of Service 80-104, Page 1 of 2 r/’ \“ - pr ,. ; ‘ /\ 7/ Case Number: Case Name: WV» AVA)“WIN V5 (Ml) flm 140 560g? 3 q 0 ® -Fill out “a” or “b” below: a. D Personal Service: I personally gave copies of the documents checked in ® to the person in® 0n (date): At (time): D am. D p.m. At this address: City: State: Zip: b.E Substituted Service: Ipcrsonally gave copies ofthe documents checked in ® (a, b, 0r d) to (check one): A competent adult (at least 18) at the home of, and living with the person in C1) , or 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), ifthcre is no known physical address for the person in ®. Itold that adult, "Please give these couIT papers to (name ofperson in (1)). AN FbAm I did this on (date): fl, 74 « (LO At (time)fi {2Q E am. D pm. At this addr'essfl 9 330 fl [fl v.47») 4; City: SW {alga Statezéjé Zip: g2 [1:1 Name or description ofthc person I gave the papers to: I/C LLAA/ [9%fl I Afier serving the court papers, 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 lefi the copies. Imailed the envelope on (date): (7r Q] ~ 10 fiom (city, state):§A\/ Mk5; Q1 by leaving it (check one): a. WM a U.S. Postal Service mail drop, or b- D At an oflice 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- 1 04A. ® Server’sln ation - Name; , (\an W 229a]; Phone: 5:6 3’15ab?5/; Address (ifknown): PO (fax 72.5”; City; 9W CW; Statechg Zip: 9‘14070 Fee for service: $ \ O O.w Ifyou are a registeredprocess server: County ofregistration: 9AM MAMQ Registration number: 1H. n v ‘ I ‘ ‘-® I declare under penalty of peljury under California state law thatI am at least 18 years old and not named in this case and that the information above is true and correct. Date: 2v 13/29 /___ Type 0rprint server 3' name Server sig‘fis here afier serving Revised January 1.2009 Proof of Service sc-1o4, Page 20f 2 (Small Claims _F"o"r you; pr6té€tion and "pfiiiiacy! please press tfié 'CI‘e’aTl ‘ ‘ Ehis‘Form button after yqu‘have printe'd’the form. 1; [Print this form I [ save this form féfizfifiis form