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
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
a perior Courtof California
unty of San Francisco
Business or Public Entity, Form SC-104C.
To serve a business, you must serve one of the following people:
AUG 2 3 2023
* Owner
+ Partner
(for a sole proprietorship)
(for a partnership) or general partner (for a limited partnership)
+ Any officer or general manager (corporation or association)
BY: LBUBEBARALGUp)
CLERIBEB
Deputy Clerk
Fill in court name and street address:
+ Any person authorized for service by the business (corporation, association,
general partnership, limited partnership) Superior Court of California, County of
+ Any person authorized for service with the Secretary of State (corporation,
association, limited liability company [LLC], limited liability partnership
400 McAllister Ru.
[LLP], limited partnership) SF oft Quio2
To serve a public entity, you must first file a claim with that entity, then
erve one of the following people:
Fill in case number, case name, hearing date,
+ Clerk (of a city or county) day, time, and department below:
+ Chief officer or director (of a public agency) Case Number:
+ Any person authorized for service by the entity COM -23- FOF 2A
a. Ifyou are serving a person, write the person’s name below:
pio
Case Name:
ik mel s
b. Ifyou are serving a business or entity, write the name of the business
Poytillo vs Shapira
or entity, the person authorized for service, and that person’s job title: [Hearing Date: | "12%
Business or Agency Name Time: $10 QW | Dept.
Person Authorized for Service Job Title
(2) Instructions to Server:
You must be at least 18 years old and not be named in this case. Follow these steps: a
+ 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 @ ore
b. An adult (at least 18) who seems to be in charge at the usual workplace of the person in (1) , or
c. An adult (at least 18) who seems to be in charge where the person in (4) 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
dat
the form to be filed with the court at least 5 days before the hearing.
I serves the person in (4) a copy of the documents checked below:
a. SC-100, Plaintiff's Claim and ORDER to Go to Small Claims Court
b. 1] 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.
(1) C1 SC-134, Application and Order to Produce Statement of Assets and to Appear for Examination
(2) 01 AT-138/EJ-125, Application and Order for Appearance and Examination
d. ( Other (specify):
Judicial Council of California, www.courts.ca.gov Proof of Service
Revised January 1, 2008, Optional Form SC-104, Page 1 of 2
Case Number:
Case name: Yo +i lle Vs Sh api vO
CSM ~23- BO HIN
Fill out “a” or “b” below:
a. C1 Personal Service: I personally gave copies of the documents checked in () to the person in ®
On (date): At (time): Olam. 0 pm.
At this address:
City: State: Zip:
db. 1 Substituted Service: I personally gave copies of the documents checked in ® (a, b, or d) to (check one):
wa competent adult (at least 18) at the home of, and living with the person in @ ,or
C1 An adult who seems to be in charge where the person in @ usually works, or
OO 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 physi ical address for the person in (1).
I told that adult, "Please give these court papers to (name of person in (1))."
I did this on (date): gliz/22 At (time): (0°25 O am. om.
Atthis address: 102.8 Wowavd St. Ke
tt t
304
City: SE State: Cf& — Zip: 44103
Name or description of the person I gave the papers to:
Shapivd's wméther
After serving the court papers, I put copies of the documents listed in@) in an envelope, scaled the envelope,
and put first-class prepaid postage on it. I addressed the envelope to the person in Mat the address where I
left the copies.
I mailed the envelope o1-(datéy=3 %| Al 2 » from (city, state): Ss ‘cf
twats
by leaving. it (check one):
a. ‘At a U.S. Postal Service mail drop, or
b. CL] Atan office or business mail drop where I know the mail is picked up every day and deposited with
the U.S. Postal Service, or
c. [] With someone else I asked to mail the documents to the person in (4) , and I have attached that person’ s
completed Form SC-104A.
® Server’s Information
Name: Marla Galeand Phone: A\S- 3l 2- 20028
Address: \S@O Geneva Ave *3
City: SE State: CA Zip: QYID
Fee for service: $ Q
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 ap
and that the i above is true and correct.
Date
Morla_
Type or print’server s name
faleand >Server signs here ter serving
Revised January 1, 2009 Proof of Service SC-104, Page 2 of 2
(Small Claims)
on af
no form: Save this form |
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 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 a perior Courtof California unty of San Francisco Business or Public Entity, Form SC-104C. To serve a business, you must serve one of the following people: AUG 2 3 2023 * Owner + Partner (for a sole proprietorship) (for a partnership) or general partner (for a limited partnership) + Any officer or general manager (corporation or association) BY: LBUBEBARALGUp) CLERIBEB Deputy Clerk Fill in court name and street address: + Any person authorized for service by the business (corporation, association, general partnership, limited partnership) Superior Court of California, County of + Any person authorized for service with the Secretary of State (corporation, association, limited liability company [LLC], limited liability partnership 400 McAllister Ru. [LLP], limited partnership) SF oft Quio2 To serve a public entity, you must first file a claim with that entity, then erve one of the following people: Fill in case number, case name, hearing date, + Clerk (of a city or county) day, time, and department below: + Chief officer or director (of a public agency) Case Number: + Any person authorized for service by the entity COM -23- FOF 2A a. Ifyou are serving a person, write the person’s name below: pio Case Name: ik mel s b. Ifyou are serving a business or entity, write the name of the business Poytillo vs Shapira or entity, the person authorized for service, and that person’s job title: [Hearing Date: | "12% Business or Agency Name Time: $10 QW | Dept. Person Authorized for Service Job Title (2) Instructions to Server: You must be at least 18 years old and not be named in this case. Follow these steps: a + 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 @ ore b. An adult (at least 18) who seems to be in charge at the usual workplace of the person in (1) , or c. An adult (at least 18) who seems to be in charge where the person in (4) 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 dat the form to be filed with the court at least 5 days before the hearing. I serves the person in (4) a copy of the documents checked below: a. SC-100, Plaintiff's Claim and ORDER to Go to Small Claims Court b. 1] 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. (1) C1 SC-134, Application and Order to Produce Statement of Assets and to Appear for Examination (2) 01 AT-138/EJ-125, Application and Order for Appearance and Examination d. ( Other (specify): Judicial Council of California, www.courts.ca.gov Proof of Service Revised January 1, 2008, Optional Form SC-104, Page 1 of 2 Case Number: Case name: Yo +i lle Vs Sh api vO CSM ~23- BO HIN Fill out “a” or “b” below: a. C1 Personal Service: I personally gave copies of the documents checked in () to the person in ® On (date): At (time): Olam. 0 pm. At this address: City: State: Zip: db. 1 Substituted Service: I personally gave copies of the documents checked in ® (a, b, or d) to (check one): wa competent adult (at least 18) at the home of, and living with the person in @ ,or C1 An adult who seems to be in charge where the person in @ usually works, or OO 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 physi ical address for the person in (1). I told that adult, "Please give these court papers to (name of person in (1))." I did this on (date): gliz/22 At (time): (0°25 O am. om. Atthis address: 102.8 Wowavd St. Ke tt t 304 City: SE State: Cf& — Zip: 44103 Name or description of the person I gave the papers to: Shapivd's wméther After serving the court papers, I put copies of the documents listed in@) in an envelope, scaled the envelope, and put first-class prepaid postage on it. I addressed the envelope to the person in Mat the address where I left the copies. I mailed the envelope o1-(datéy=3 %| Al 2 » from (city, state): Ss ‘cf twats by leaving. it (check one): a. ‘At a U.S. Postal Service mail drop, or b. CL] Atan office or business mail drop where I know the mail is picked up every day and deposited with the U.S. Postal Service, or c. [] With someone else I asked to mail the documents to the person in (4) , and I have attached that person’ s completed Form SC-104A. ® Server’s Information Name: Marla Galeand Phone: A\S- 3l 2- 20028 Address: \S@O Geneva Ave *3 City: SE State: CA Zip: QYID Fee for service: $ Q 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 ap and that the i above is true and correct. Date Morla_ Type or print’server s name faleand >Server signs here ter serving Revised January 1, 2009 Proof of Service SC-104, Page 2 of 2 (Small Claims) on af no form: Save this form |