Mendocino — SC-104

Source: http://www.courts.ca.gov/documents/sc104.pdf

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, Fill in court name and street address: 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 [LLP], limited partnership) To serve a public entity, you must first file a claim with that entity, then serve 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 1 a. If you are serving a person, write the person’s name below: Case Name:

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 Date:

Business or Agency Name Time: 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: • 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. SC-100, Plaintiff’s Claim and ORDER to Go to Small Claims Court b. 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) 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. Other (specify):

www.courts.ca.govJudicial Council of California,

Revised January 1, 2009, Optional Form Proof of Service SC-104, Page 1 of 2 Code of Civil Procedure, §§ 116.340, 415.10, 415.20 (Small Claims)

Case Number: Case name:

4 Fill out “a” or “b” below: a. Personal Service: I personally gave copies of the documents checked in 3 to the person in 1 On (date): At (time): a.m. p.m. At this address: City: State: Zip:

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): a.m. p.m.
At this address:
City: State: Zip:
Name or description of the person I gave the papers to:

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 persons’
completed Form SC-104A.

5 Server ’s Information Name: Phone: Address: City: State: Zip: Fee for service: $ If you are a registered process server: County of registration: Registration number: 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 SC-104, Page 2 of 2 (Small Claims) For your protection and privacy, please press the Clear This Form button after you have printed the form. Print this form Save this form Clear this form