Preview
aI
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 "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.
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 or 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 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:
+ 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. Ifyou 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:
SAN FRANCESCO Free D&PAGIMEDT
Business or Agency Name
Count 4 cuee ek
bine @
fe SA Job Title
Person Authorized for Service
@) Instructions to Server:
You must be at least 18 years old and not be named in this case. Follow these steps:
Clerk stamps date here whe
form is filed.
Fillin court name and street address:|
SAN FRANCESCO
4400 MeALUST te
SAN FRANCLS CO,
Case Number:
COM-Z2- 3 6G
Case Name:
GARN CA WILLIA TAG
SAN FRANC. Sco ered! OErneImEsT
Superior Court of California, County of
cH AY (0L,
Fill in case number, case name,
day, time, and department below,
Judicial Council of California, www.courts.ca.gov
Revised Januarv 1. 2009. Ontional Form
* Give a copy of all the documents checked in ® to the person in @, or
« 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 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 of the documents left with one of the adults in a, b, or 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 time for
. |
the form to be filed with the court at least 5 days before the hearing.
I served the person in (4) a copy of the documents checked below:
stecet
earing date,
a
L
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. Check the form that was served):
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 registered process server, sheriff, marshal, or someone appointed by the court.
() 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 } ‘
d. Other (specify): I
Proof of Service |
SG-104, Page 1 of 2Case Number: |
Case name: BIANCA WILLIAMS vs SA FeAncisco fice D: CSM 22
glose
(4) Fill out “a” or “b” below:
a. Personal Service: I personally gave copies of the documents checked in ® to the person in 1)
On (date): At (time): am. pm.
At this address: ! :
City: : State: Zip:, '
b. & Substituted Service: I personally gave copies of the documents checked in ® (a, b, or d) to (check one):
~} An adult who seems to be in charge where the person in a) usually works, or |
7
I told that adult, "Please give these court papers to (name of person in @)."
I did this on (date): JA/F@/2O2ZR At (time): _]} Of am.
At this address: Qo pp. CARLTON B. GoooltT Place #ICY
A competent adult (at least 18) at the home of, and living with the person in @ 3 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 petson in @) :
City: Snow Peaticesco State: CA__ Zip: 4 yo |
Name or description of the person I gave the papers to:
Cunsemo Sansa , ciner cree
After serving the court papers, I put copies of the documents listed in@) inan envelope, sealed! thee Vvelope,
and put first-class prepaid postage on it. I addressed the envelope to the person in @at the address where I
: '
left the copies.
I mailed the envelope on (date): J. /9 R022 from (city, state): SAN FOANCSC: ,CA-
by leaving it (check one):
a. B® Ata US. Postal Service mail drop, or !
the U.S. Postal Service, or
completed Form SC-104A.
@) Server’s Information
b. At an office or business mail drop where I know the mail is picked up every day. and depo: ited with
c. With someone else I asked to mail the documents to the person in (1) , and I have attached! that person’ s
Name: NEDA Sthertearwy Phone: 4I6-S43, 944
Address: [Bl STEUACT ST. Sure HOO
City: San Ferwnets co State: CA Zip: F4LOE>
Fee for service: $ ES
If you are a registered process server:
County of registration: Mh Registration number: M// A+
T
@) 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 information above is true and correct.
Date: 10/7 [O22
NEDA Sthrthennn »
Type or print’server s name Server signStere after serving
Revised January 1, 2009 Proof of Service . son
(Small Claims)
For your protection and privacy, please press the Clear .
This Form button after you have printed the form. [ Print this form | | Save this form |
Preview
aI 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 "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. 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 or 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 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: + 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. Ifyou 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: SAN FRANCESCO Free D&PAGIMEDT Business or Agency Name Count 4 cuee ek bine @ fe SA Job Title Person Authorized for Service @) Instructions to Server: You must be at least 18 years old and not be named in this case. Follow these steps: Clerk stamps date here whe form is filed. Fillin court name and street address:| SAN FRANCESCO 4400 MeALUST te SAN FRANCLS CO, Case Number: COM-Z2- 3 6G Case Name: GARN CA WILLIA TAG SAN FRANC. Sco ered! OErneImEsT Superior Court of California, County of cH AY (0L, Fill in case number, case name, day, time, and department below, Judicial Council of California, www.courts.ca.gov Revised Januarv 1. 2009. Ontional Form * Give a copy of all the documents checked in ® to the person in @, or « 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 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 of the documents left with one of the adults in a, b, or 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 time for . | the form to be filed with the court at least 5 days before the hearing. I served the person in (4) a copy of the documents checked below: stecet earing date, a L 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. Check the form that was served): 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 registered process server, sheriff, marshal, or someone appointed by the court. () 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 } ‘ d. Other (specify): I Proof of Service | SG-104, Page 1 of 2Case Number: | Case name: BIANCA WILLIAMS vs SA FeAncisco fice D: CSM 22 glose (4) Fill out “a” or “b” below: a. Personal Service: I personally gave copies of the documents checked in ® to the person in 1) On (date): At (time): am. pm. At this address: ! : City: : State: Zip:, ' b. & Substituted Service: I personally gave copies of the documents checked in ® (a, b, or d) to (check one): ~} An adult who seems to be in charge where the person in a) usually works, or | 7 I told that adult, "Please give these court papers to (name of person in @)." I did this on (date): JA/F@/2O2ZR At (time): _]} Of am. At this address: Qo pp. CARLTON B. GoooltT Place #ICY A competent adult (at least 18) at the home of, and living with the person in @ 3 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 petson in @) : City: Snow Peaticesco State: CA__ Zip: 4 yo | Name or description of the person I gave the papers to: Cunsemo Sansa , ciner cree After serving the court papers, I put copies of the documents listed in@) inan envelope, sealed! thee Vvelope, and put first-class prepaid postage on it. I addressed the envelope to the person in @at the address where I : ' left the copies. I mailed the envelope on (date): J. /9 R022 from (city, state): SAN FOANCSC: ,CA- by leaving it (check one): a. B® Ata US. Postal Service mail drop, or ! the U.S. Postal Service, or completed Form SC-104A. @) Server’s Information b. At an office or business mail drop where I know the mail is picked up every day. and depo: ited with c. With someone else I asked to mail the documents to the person in (1) , and I have attached! that person’ s Name: NEDA Sthertearwy Phone: 4I6-S43, 944 Address: [Bl STEUACT ST. Sure HOO City: San Ferwnets co State: CA Zip: F4LOE> Fee for service: $ ES If you are a registered process server: County of registration: Mh Registration number: M// A+ T @) 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 information above is true and correct. Date: 10/7 [O22 NEDA Sthrthennn » Type or print’server s name Server signStere after serving Revised January 1, 2009 Proof of Service . son (Small Claims) For your protection and privacy, please press the Clear . This Form button after you have printed the form. [ Print this form | | Save this form |