SC-112A Proof of Service by Mail

Proof of Service by Mail
(Small Claims)
SC-112A
Case Number:
Proof of Service by Mail
This form is attached to the document checked in d below.
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 #:
Form or document served
a.
b.
c.
d.
e.
f.
g.
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 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.
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.
Judicial Council of California, www.courtinfo.ca.gov
New July 1, 2010, Optional Form
Cal. Rules of Court, rule 3.2107
SC-112A
I placed copies of the document checked in d and an unsigned copy of this page in a sealed envelope,
addressed as follows:
b.
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
On (date of mailing): , I placed each envelope in the mail, with postage paid, at
(city and state of mailing):
c.
I declare under penalty of perjury under the laws of the State of California that the information above is true and correct.
e
c
d
Date:
Type or print server’s name Server signs here
See instructions on other side.
To keep other people from seeing what you entered on your form, please press
the Clear This Form button at the end of the form when finished.
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SC-112A Proof of Service by Mail PDF

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