Preview
Cletn 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 FILED
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. 08/30/2 ‘O17
To serve a business, you must serve one of the following people: Sherri er, icer # Clerk
* Owner (for a sole proprietorship)
+ Partner (for a partnership) or general partner (for a limited partnership) By: Deputy
Katri dsey
+ Any officer or general manager (corporation or association)
+ 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 Los Angeles
[LLP], limited partnership) Small Claims Court
To serve a public entity, you must first file a claim with that entity, then Michael Antonovich Antelope
serve one of the following people: 42011 4th Street West
* Clerk (ofa city or county) Lancaster, CA 93534
* 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 serving a person, write the person’s name below:
17AVSC01230
GABRIEL GUTIERREZ
Case Name:
b. If you are serving a business or entity, write the name of the business
Don Roberto Jewelers, Inc. vs.
or entity, the person authorized for service, and that person’sjob title:
GABRIEL GUTIERREZ
Hearing Date:
Business or Agency Name 10-02-2017
Person Authorized for Service Job Title Time: 8:30 am Dept: A-22
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(4).
and mail a copy of the documents left with one of the adults in a, b, or ¢ 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
dad)
the form to be filed with the court at least 5 days before the hearing.
(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. O sc-120, Defendant's Claim and ORDER to Go to Small Claims Court
c. CJ 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) 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
d. O Other (specifi:
‘Judicial Council of California, www.courtinfo.ca gov Proof of Service SC-104, Page 1 of2
Revised January 1, 2009, Optional Form
Code of Civil Procedure, §§ 116.340, 415.10, 415.20 (Small Claims)
Preview
Cletn 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 FILED 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. 08/30/2 ‘O17 To serve a business, you must serve one of the following people: Sherri er, icer # Clerk * Owner (for a sole proprietorship) + Partner (for a partnership) or general partner (for a limited partnership) By: Deputy Katri dsey + Any officer or general manager (corporation or association) + 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 Los Angeles [LLP], limited partnership) Small Claims Court To serve a public entity, you must first file a claim with that entity, then Michael Antonovich Antelope serve one of the following people: 42011 4th Street West * Clerk (ofa city or county) Lancaster, CA 93534 * 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 serving a person, write the person’s name below: 17AVSC01230 GABRIEL GUTIERREZ Case Name: b. If you are serving a business or entity, write the name of the business Don Roberto Jewelers, Inc. vs. or entity, the person authorized for service, and that person’sjob title: GABRIEL GUTIERREZ Hearing Date: Business or Agency Name 10-02-2017 Person Authorized for Service Job Title Time: 8:30 am Dept: A-22 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(4). and mail a copy of the documents left with one of the adults in a, b, or ¢ 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 dad) the form to be filed with the court at least 5 days before the hearing. (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. O sc-120, Defendant's Claim and ORDER to Go to Small Claims Court c. CJ 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) 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 d. O Other (specifi: ‘Judicial Council of California, www.courtinfo.ca gov Proof of Service SC-104, Page 1 of2 Revised January 1, 2009, Optional Form Code of Civil Procedure, §§ 116.340, 415.10, 415.20 (Small Claims)