SC-104A Proof of Mailing (Substituted Service)

This form is attached to Form SC-104. Use this form ONLY if you mailed the documents in and someone else
personally gave them to the person, business, or public entity served.
Notice to Server
Documents served by mail:
Name and address of the person, business, or public entity served:
I put copies of the documents listed in above in an envelope, sealed the envelope, and put first-class prepaid
postage on it. I addressed the envelope to the person, business, or public entity listed in and mailed the envelope
by leaving it at (check one):
I mailed the envelope:
I declare, under penalty of perjury under California State law, that the information above is true and correct.
Server signs here after mailing
Type or print server’s name
1
2
3
4
5
My address is:
6
Fill out – of this form and attach it to Form SC-104.
Be at least 18 and not listed in this lawsuit.
1
6
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. Other (specify):
1
a. A U.S. Postal Service mail drop or
b. An office or business mail drop where I know the mail is picked up every day and deposited with the
U.S. Postal Service.
a. On (date): b. From (city, state):
1
SC-104A, Page 1 of 1
Judicial Council of California, www.courtinfo.ca.gov
Revised January 1, 2006, Optional Form
Code of Civil Procedure, §§ 116.340, 415.20
Proof of Mailing (Substituted Service)
(Small Claims)
Date:
SC-104A
Case Number:
Proof of Mailing (Substituted Service)
b. If you served a business or public entity, write the name and address of the business or public entity, the person
authorized for service, and that person’s job title:
a. If you served a person, write the person’s name and address below:
Business or Public Entity Name Person Authorized for Service Job Title
2
You must:
Address:
Street City State Zip
Name:
Address:
Street City State Zip
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when finished.
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SC-104A Proof of Mailing (Substituted Service) PDF

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