Form SC-104 at a glance
What it is: SC-104 Proof of Service: use this form to serve a person, a business, or a public entity.
Who signs: Type or print server's name. Server signs here after serving.
A filled-in Form SC-104 example: a server proves personal service of an SC-100
How to fill out Form SC-104, box by box
Court name and street address
Fill in court name and street address: Superior Court of California, County of.
Case number, case name, hearing date, day, time, and department
Fill in case number, case name, hearing date, day, time, and department.
If you are serving a person
If you are serving a person, write the person's name.
If you are serving a business or entity
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.
The documents checked below
Check SC-100, Plaintiff's Claim and ORDER to Go to Small Claims Court, if that is the form you served.
Check 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.
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.
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.
Other (specify).
Personal Service
Fill out “a” or “b”.
Personal Service: I personally gave copies of the documents checked to the person at the address, at the time and on the date.
Substituted Service
Substituted Service: I personally gave copies of the documents checked (a, b, or d) to a competent adult (at least 18) at the home of, and living with the person.
An adult who seems to be in charge where the person usually works.
An adult who seems to be in charge where the person 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. I told that adult, "Please give these court papers to (name of person)."
At (time) and on (date), at the address: name or description of the person I gave the papers to.
After serving the court papers
After serving the court papers, I put copies of the documents listed in an envelope, sealed the envelope, and put first-class prepaid postage on it.
I addressed the envelope to the person at the address where I left the copies.
I mailed the envelope on this date, from this city and state, by leaving it at a U.S. Postal Service mail drop.
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.
With someone else I asked to mail the documents to the person, and I have attached that person's completed Form SC-104A.
Server's Information
Server's Information: Name, Phone, Address, City, State and Zip.
Fee for service
Fee for service: $.
If you are a registered process server
If you are a registered process server: County of registration, Registration number.
I declare under penalty of perjury under California state law
By signing, 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 is true and correct.
Date.
Type or print server's name. Server signs here after serving.
More rules for Form SC-104
You must be at least 18 years old and not be named in this case.
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), or 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), or any person authorized for service by the entity.
Complete and sign this form, then 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.
Sources
[1] Form SC-104 (Revised January 1, 2009), Proof of Service (Small Claims), Judicial Council of California (the Official source link on this page).