Preview
Clerk stamps date here when form is filed.
Proof of Service
Use this form to serve a person, a business, or a public entity. To learn more D
about proof of service, read What Is "Proofof Service"?, Form SC-104B. To Superior Court of California
learn more about how to serve a business or entity, read How to Serve a County of Los Angeles
Business or Public Entity, Form SC-104C. 12/27/2017
To serve a business, you must serve one of the following people: Sherri ‘arter, Execati icer f Clerk
+ Owner (for a sole proprietorship)
+ Partner (for a partnership) or general partner (for a limited partnership) By: Deputy
+ Any officer or general manager (corporation or association) Myesha Jenkins
+ Any person authorized for service by the business (corporation, association,
general partnership, limited partnership) Fill in court name and street address:
+ Any person authorized for service with the Secretary of State (corporation, Superior Court of California, County of
association, limited liability company [LLC], limited liability partnership
[LLP], limited partnership) Stanley Mosk Courthouse
To serve a public entity, you must first file a claim with that entity, then
111 North Hill Street
serve one of the following people: Los Angeles, CA 90012
+ Clerk (ofa city or county)
+ Chief officer or director (of a public agency) Fill in case number, case name, hearing date,
day, time, and department below:
+ Any person authorized for service by the entity
Case Number:
@) a. If you are servjng,a per: write t pers elow
\V4STSC 10722
Case Name:
(en 6. Pebomnad Haba,
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:
Hearing Pate fats, / 6
Business or Agency Name
Person Authorized for Service Job Title Time: B20 am Dept: 90
Instructions to Server:
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
* 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(1).
and mail a copy of the documents left with one of the adults in a, b, or c above to the person in (4).
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.
asd)
@) | seryéd 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. 0 sc-120, Defendant's Claim and ORDER to Go to Small Claims Court
c. (J 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.
(1) O SC-134, Application and Order to Produce Statement of Assets and to Appear for Examination
(2) (J AT-138/EJ-125, Application and Order for Appearance and Examination
d. O Other (specify):
Judicial Council of California, www. courtinfo.ca. gov Proof of Service ‘SC-104, Page 1 of 2
Revised January 1, 2009, Optional Form
Code of Civil Procedure, §§ 116.340, 415.10, 415.20 (Small Claims)
Preview
Clerk stamps date here when form is filed. Proof of Service Use this form to serve a person, a business, or a public entity. To learn more D about proof of service, read What Is "Proofof Service"?, Form SC-104B. To Superior Court of California learn more about how to serve a business or entity, read How to Serve a County of Los Angeles Business or Public Entity, Form SC-104C. 12/27/2017 To serve a business, you must serve one of the following people: Sherri ‘arter, Execati icer f Clerk + Owner (for a sole proprietorship) + Partner (for a partnership) or general partner (for a limited partnership) By: Deputy + Any officer or general manager (corporation or association) Myesha Jenkins + Any person authorized for service by the business (corporation, association, general partnership, limited partnership) Fill in court name and street address: + Any person authorized for service with the Secretary of State (corporation, Superior Court of California, County of association, limited liability company [LLC], limited liability partnership [LLP], limited partnership) Stanley Mosk Courthouse To serve a public entity, you must first file a claim with that entity, then 111 North Hill Street serve one of the following people: Los Angeles, CA 90012 + Clerk (ofa city or county) + Chief officer or director (of a public agency) Fill in case number, case name, hearing date, day, time, and department below: + Any person authorized for service by the entity Case Number: @) a. If you are servjng,a per: write t pers elow \V4STSC 10722 Case Name: (en 6. Pebomnad Haba, 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: Hearing Pate fats, / 6 Business or Agency Name Person Authorized for Service Job Title Time: B20 am Dept: 90 Instructions to Server: 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 * 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(1). and mail a copy of the documents left with one of the adults in a, b, or c above to the person in (4). 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. asd) @) | seryéd 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. 0 sc-120, Defendant's Claim and ORDER to Go to Small Claims Court c. (J 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. (1) O SC-134, Application and Order to Produce Statement of Assets and to Appear for Examination (2) (J AT-138/EJ-125, Application and Order for Appearance and Examination d. O Other (specify): Judicial Council of California, www. courtinfo.ca. gov Proof of Service ‘SC-104, Page 1 of 2 Revised January 1, 2009, Optional Form Code of Civil Procedure, §§ 116.340, 415.10, 415.20 (Small Claims)