SC-104 Proof of Service Clerk stamps date here when form is filed. 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. If you are serving a person, write the person's name below: 1 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: Business or Agency Name Person Authorized for Service Job Title Fill in court name and street address: Superior Court of California, County of Fill in case number, case name, hearing date, day, time, and department below: Case Number: Case Name: Hearing Date: Time: Dept.: 2 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 3 to the person in 1 , or � Give a copy of all the documents checked in 3 to one of the following people: a. A competent adult (at least 18) living with, and at the home of the person in 1 , or 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 1 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 1 . 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. 3 I served the person in 1 a copy of the documents checked below: a. b. c. SC-100, Plaintiff's Claim and ORDER to Go to Small Claims Court SC-120, Defendant's Claim and ORDER to Go to Small Claims Court 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) d. (2) Other (specify): SC-134, Application and Order to Produce Statement of Assets and to Appear for Examination AT-138/EJ-125, Application and Order for Appearance and Examination Judicial Council of California, www.courtinfo.ca.gov Revised January 1, 2009, Optional Form Code of Civil Procedure, �� 116.340, 415.10, 415.20 Proof of Service (Small Claims) SC-104, Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com Case Number: Case name: 4 Fill out "a" or "b" below: Personal Service: I personally gave copies of the documents checked in 3 to the person in 1 : a. On (date): At this address: City: State: Zip: At (time): a.m. p.m. 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 who seems to be in charge where the person in 1 usually works, or An adult who seems to be in charge where the person in 1 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 person in 1 . I told that adult, "Please give these court papers to (name of person in 1 )." I did this on (date): At (time): p.m. a.m. At this address: City: Name or description of the person I gave the papers to: State: Zip: After serving the court papers, 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 (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 c. With someone else I asked 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: Address: City: Fee for service: $ If you are a registered process server: County of registration: Registration number: State: Phone: Zip: 6 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: Type or print server's name Server signs here after serving Revised January 1, 2009 Proof of Service (Small Claims) SC-104, Page 2 of 2