Fill and Sign the Proof Claims Form

I served the person in a co py of the documents checked below: SC-100, Plaintiff’s Claim and ORDER to Go to Small Claims Court a. b. SC-120, Defendant’s Claim and ORDER to Go to Small Claims Court c. Order for examination (This form must be personally serve d. Check the form that was served): d. Other (specify): 3 1 • Give a copy of all the docu ments checked in to one of the following people: a. A competent adult (at least 18) living wi th, 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 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 ther e is no known physical address for the person in . and mail a copy of the documents left with one of the ad ults in a, b, or c above to the person in . SC-134, Application and Order to Prod uce Statement of Assets and to Appear for Examination (1) AT-138/EJ-125, Application and Order for Appearance and Examination (2) Note: The court can issue a civil arrest warrant if the served party does not come to court only if the order for examination was personally served by a re gistered process server, sheriff, marsha l, or someone appointed by the court. To serve a business, you must serve one of the following people: • Any person authorized for service with the Secretary of State (corporation, association, limited liability comp any [LLC], limited liability partnership [LLP], limited partnership) • Clerk (of a city or county) • Chief officer or director (of a public agency) To serve a public entity, you must first file a clai m with that entity, then serve one of the following people: SC-104 Proof of Service • Owner (for a sole proprietorship) b. If you are serving a business or entity, write the name of the business or entity, the person authorized for service, and that person’s job title: 2 SC-104, Page 1 of 2 Judicial Council of California, Revised January 1, 2009, Optional Form Code of Civil Procedure, §§ 116.340, 415.10, 415.20 Proof of Service (Small Claims) 1 Clerk stamps date here when form is filed. Fill in court name and street address: Superior Court of California, County of Case Number: Fill in case number, case name, hearing date, day, time, and department below: Instructions to Server: Use this form to serve a person, a business, or a public entity. To learn more about proof of service, read What Is "Proof of Service"?, 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-104C. • Any officer or general manager (corporation or association) • Any person authorized for service by the business (corporation, association, general partnership, limited partnership) Case Name: a. If you are serving a person, write the person’s name below: THEN • Complete and sign this form, and • Give or mail your completed form to the pe rson who asked you to serve these court papers, in time for the form to be filed with the court at least 5 days before the hearing. • Any person authorized for service by the entity • Partner (for a partnership) or gene ral partner (for a limited partnership) Hearing Date: T i me: D e pt.: You must be at least 18 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 , or 3 1 1 1 1 3 1 Business or Agency Name Person Authorized for Service Job Title 1 c. With someone else I asked to mail the documents to the person in , and I have attached that person’s completed Form SC-104A. Personal Service: I personally gave copies of the documents checke d in to the person in : a. At (time): On (date): a.m. p.m. At this address: Substituted Service: I personally gave copies of the documents checked in (a, b, or d) to (check one): b. Name or description of the person I gave the papers to: A competent adult (at least 18) at the home of, and living with the person in , or 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 )." After 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 left the copies. Server’s Information Phone: Address: If you are a registered process server: County of registration: Registration number: I declare under penalty of perjury under California state law that I am at least 18 years old and not named in this case and that the in formation above is true and correct. Date: Type or print server’s name Server signs here after serving 4 5 6 Fill out “a” or “b” below: 3 1 1 Fee for service: $ Zip: City: State: At (time): I did this on (date): a.m. p.m. At this address: Zip: City: State: Zip: City: State: Name: SC-104, Page 2 of 2 Revised January 1, 2009 Proof of Service (Small Claims) Case Number: Case name: 1 3 1 I mailed the envelope on (date): from (city, state): by leav ing it (check one): a. 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 An adult who seems to be in charge where the person in usually works, or 1 1 1 3 1