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