Form Sc 104A – Fill Out and Use This PDF

SC-104A

ATTACHMENT TO FORM SC-104: PROOF OF MAILING AFTER SUBSTITUTED SERVICE (Small Claims)

(This form must be (1) filled out, (2) signed by the person who mailed the documents, and (3) attached to form SC-104, Proof of Service (Small Claims), when the mailing required to complete substituted service under Code of Civil Procedure section 415.20 (item 5b(5) on form SC-104) is performed by a different person than the person who left copies of documents to be served with suitable persons as required by that section.)

1.I am over the age of 18 and not a party to this case. I am a resident of or employed in the county where the mailing took place.

2.My residence or business address is (specify):

3.I served the documents listed in item 2 of the attached Proof of Service (Small Claims), form SC-104, on each person named below by enclosing a copy in an envelope addressed to each person whose name and address are shown below AND

a.		depositing the sealed envelope with the United States Postal Service on the date and at the place shown in item 4
		with first class postage fully	prepaid.
b.		placing the envelope for collection and mailing on the date and at the place shown in item 4 following our
		ordinary business practices. I am readily familiar with this business's practice for collecting and processing
		correspondence for mailing. On the same day that correspondence is placed for collection and mailing, it is
		deposited in the ordinary course of business with the United States Postal Service in a sealed envelope with first
		class postage fully prepaid.
4. a.	Date mailed:		b. Place mailed (city, state):

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Date:

(TYPE OR PRINT NAME)(SIGNATURE OF DECLARANT)

NAME AND ADDRESS OF EACH PERSON TO WHOM DOCUMENTS WERE MAILED

Name	Address (number, street, city, and zip code)

1.

2.

3.

4.

5.

6.

List of names and addresses continued on separate attachment or Attachment to Judicial Council Form (form MC-025).

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	Form Approved for Optional Use	ATTACHMENT TO FORM SC-104: PROOF OF MAILING	Code of Civil Procedure
	Judicial Council of California		§§ 116.340, 415.20
		AFTER SUBSTITUTED SERVICE (Small Claims)
	SC-104A [New January 1, 2005]		www.courtinfo.ca.gov