Mendocino — SC-112A

Source: http://www.courts.ca.gov/documents/sc112a.pdf

SC-112A Proof of Service by Mail Case Number:

See instructions on other side. þ This form is attached to the document checked in 2 below. 1 Server’s information Name: Phone: Street or mailing address: City: State: Zip Code: Check here if you are a registered process server, and write: County where registered: Registration #:

2 Form or document served a. Form SC-105, Request for Court Order and Answer b. Form SC-109, Authorization to Appear c. Form SC-114, Request to Amend Claim Before Hearing d. Form SC-133, Judgment Debtor’s Statement of Assets e. Form SC-150, Request to Postpone Trial f. Form SC-221, Response to Request to Make Payments g. Other document allowed to be served by mail (specify): Check here if there is not enough space below to list the document served. List the document on a separate page, and write “SC-112A, Item 2” at the top.

3 Server’s declaration a. I am 18 or older. I am not a party to this small claims case. I live or work in the county where I did the mailing described below. b. I placed copies of the document checked in 2 and an unsigned copy of this page in a sealed envelope, addressed as follows: Check here if there is not enough space below to list all parties served. List their names and addresses on a separate page, and write “SC-112A, Item 3” at the top. Name of party served Mailing address on the envelope

c. On (date of mailing): , I placed each envelope in the mail, with postage paid, at
(city and state of mailing):

I declare under penalty of perjury under the laws of the State of California that the information above is true and correct. Date:

Type or print server’s name Server signs here

Judicial Council of California, courts.ca.gov SC-112A, Page 1 of 2Rev. July 1, 2025, Optional Form Proof of Service by Mail Cal. Rules of Court, rule 3.2107 (Small Claims)

Instructions for form SC-112A, Proof of Service by Mail (This page is not part of the Proof of Service and does not need to be copied, served, or filed.) Form SC-112A can be used to show the court that these documents were served by mail: Form SC-105, Request for Court Order and Answer Form SC-109, Authorization to Appear Form SC-114, Request to Amend Claim Before Hearing Form SC-133, Judgment Debtor’s Statement of Assets Form SC-150, Request to Postpone Trial Form SC-221, Response to Request to Make Payments Other documents that are allowed to be served by mail Form SC-112A cannot be used to prove service of these forms: Form SC-100, Plaintiff’s Claim and ORDER to Go to Small Claims Court Form SC-120, Defendant’s Claim and ORDER to Go to Small Claims Court For information about serving these forms, see form SC-104, Proof of Service, and form SC-104B, What Is “Proof of Service”? The server (the person who will do the mailing): Must not be a party (plaintiff or defendant) in the case May be a friend, relative, co-worker, or other helpful person Must be 18 or older Must live or work in the county where the mailing takes place Follow these steps to use form SC-112A:

1. Prepare form SC-112A by filling in: The case number The document to be served, in item 2 * The names and addresses of the parties to be served, in item 3 *Prepare a separate form SC-112A for each document to be served.
2. Give the server: The partially completed form SC-112A One copy of the document to be served for each party to be served
3. Ask the server to: Fill out the remainder of the form SC-112A. Mail each party to be served: An unsigned copy of the completed form SC-112A and The document to be served (checked in item 2 ). • Sign a separate form SC-112A for each document served and give it to back you.
4. File these papers with the small claims court clerk: The original of each document served, with The signed, original Proof of Service by Mail attached Need help? For free help, contact your county’s small claims advisor: ? [local info here] Or visit selfhelp.courts.ca.gov/small-claims-advisor.

Rev. July 1, 2025 Proof of Service by Mail SC-112A, 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