Fill and Sign the Proof Claims 497299524 Form

Clerk stamps date here when form is filed. SC-104 Proof of Service Use this form to serve a person, business, or public entity . To learn more about proof of service, read Form SC-104B, What Is Proof of Service? To learn more about how to serve a business or public entity , read Form SC-104C, How to Serve a Business. To serve a business, you must serve one of the following people: • Owner (for a sole proprietorship or a business, form unknown) • Partner (for a partnership) or general partner (for a limited partnership) • Any officer or general manager (corporation or association) • Any person authorized for service by the business (corporation, association, Fill in court name and street address: general partnership, limited partnership) Superior Court of California, County of • Any person authorized for service with the Secretary of Stat e ––––– (corporation, association, limited-liability company (LLC), limited- ––––– liability partnership (LLP), limited partnership) To serve a public entity, you must serve one of the following people: • Clerk (of a city or county) • Chief officer, director, or agent authorized to accept service (of a public Fill in case number and case name: entity , agency, commission, board, district, etc.) Case Number: 1 a. If you are serving a person, write the person’s name below: ––––– ––––– Case Name: b. If you are serving a business or public entity, write the name of the ––––– business or entity, the person authorized for service, and that person’s job title: ––––– Business or Public Entity Name Person Authorized for Service Job Title 2 Instructions to Server You must be at least 18 years old and not listed in this case. You can use personal or substituted service. Follow these steps: a. If you are using personal service, give a copy of the documents checked in 3 to the person in 1 . b. If you are using substituted service, give a copy of the documents checked in 3 to: • A competent adult (at least 18) at the home of and living with the person in 1 or • An adult (at least 18) who seems to be in charge where the person usually works or • An adult (at least 18) who seems to be in charge at the place where the person receives mail or has a private mailbox (not a U.S. Postal Service P.O. Box), if there is no known physical address for the person in 1 . • THEN mail a copy of the documents to the person in 1 at the address where you left the documents. c. After serving the documents do the following: • Complete and sign this form and • Give or mail your completed form to the person who asked you to serve these court papers. 3 I served the person in 1 a copy of the documents checked below: a. SC-100, Plaintiff’s Claim and ORDER to Go to Small Claims Court b. SC-120, Defendant’s Claim and ORDER to Go to Small Claims Court c. Order for Examination (This form must be personally served. Put a check mark next to the form that was served): (1) SC-134, Application and Order to Produce Statement of Assets and to Appear for Examination (2) AT-138/EJ-125, Application and Order for Appearance and Examination Note: The court can issue a civil arrest warrant if the served party does not come to court but only if the Order for Examination was personally served by a registered process server, sheriff, marshal, or someone appointed by the court. d . Other (specify): ––––– Judicial Council of California, SC-104, Page 1 of 2 Revised January 1, 2006, Optional Form ------------- à Code of Civil Procedure, §§ 116.340, 415.10, 415.20 electronic form ã 2005 WWW.LawCA.co m Law Publishers Case Number: Case name: ––––– ––––– 4 Fill out “a” or “b” below: a. Personal Service: I personally gave copies of the documents checked in 3 to the person in 1 : On (date): ––––– At (time): ––––– a.m p.m. At this address: ––––– City: ––––– State: ––––– Zip: ––––– b. Substituted Service: I personally gave copies of the documents checked in 3 (a, b, or d) to (check one): A competent adult (at least 18) at the home of, and living with the person in, 1 or An adult (at least 18) who seems to be in charge where the person in 1 usually works or An adult (at least 18) who seems to be in charge where the person in 1 receives mail, or has a private mailbox (not a U.S. Postal Service P.O. Box), if there is no known physical address for the person in 1 . I told that adult (check one): “Please give these court papers to ( name of person in 1 )” Other (specify): ––––– I did this on (date): ––––– At (time): ––––– a.m. p.m. At this address: ––––– City: ––––– State: ––––– Zip: ––––– Name or description of the person I gave the papers to: ––––– After serving the court papers (check one): 1. I put copies of the documents listed in 3 in an envelope, sealed the envelope, and put first-class prepaid postage on it. I addressed the envelope to the person in 1 at the address where I left the copies. I mailed the envelope on (date): ––––– from (city, state): ––––– by leaving it at (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 2. I gave copies of the documents to someone else and asked that person to mail the documents to the person in 1 , and I have attached that person’s completed Form SC-104A. 5 Server’s Information Name: ––––– Phone: ––––– Address: ––––– City: ––––– State: ––––– Zip: ––––– Fee for service: $ ––––– (If you are a registered process server): County of registration: ––––– Registration number: ––––– 6 I declare, under penalty of perjury under California State law, that I am at least 18 years old and not listed in this case and that the information above is true and correct. Date: ––––– ––––– Type or print server’s name Server signs here after serving Revised January 1, 2006 Proof of Service SC-104, Page 2 of 2 (Small Claims)