Judicial Council of California Form SC-104, Proof of Service (Small Claims) Instructions

Provide any additional notes or details about how the service was completed that are not captured elsewhere on the form.

Enter the name or title of the case.

Enter the court-assigned case number.

Enter the name of the court and the court’s street address where the case is filed.

Enter the court-assigned case number for this matter.

Enter the case name as it appears on the court records.

Enter the date of the hearing for this case.

Enter the time the hearing is scheduled to begin.

Enter the court department number or letter where the hearing will be held.

Enter the date you are signing the declaration under penalty of perjury.

Type or print the full name of the person who served the documents.

Check this box if the server delivered a copy of form SC-100 to the person served.

Check this box if the server delivered a copy of form SC-120 to the person served.

Check this box if the server delivered an Order for examination to the person served.

Check this box if the Order for examination served was form SC-134. Fill only if 'Order for examination' is 'Yes'.

Check this box if the Order for examination served was form AT-138/EJ-125. Fill only if 'Order for examination' is 'Yes'.

Enter the date you mailed the envelope containing copies of the served documents.

Enter the city and state you mailed the envelope from.

Check this box if you mailed the envelope by leaving it at a U.S. Postal Service mail drop.

Check this box if you mailed the envelope by leaving it at an office or business mail drop where you know the mail is picked up daily and deposited with the U.S. Postal Service.

Check this box if someone else you asked mailed the documents and you attached that person’s completed Form SC-104A.

Check this box if you served a document that is not one of the listed forms, and then specify the document name on the line provided.

Enter the name or description of the other document that was served. Fill only if 'Other (specify)' is 'Yes'.

Check this box if you personally gave copies of the documents to the person being served.

Enter the date on which you personally delivered the documents. Fill only if 'Personal Service' is 'Yes'.

Enter the time at which you personally delivered the documents. Fill only if 'Personal Service' is 'Yes'.

Check this box if the time you served the documents was in the morning (a.m.). Fill only if 'Personal Service' is 'Yes'.

Check this box if the time you served the documents was in the afternoon/evening (p.m.). Fill only if 'Personal Service' is 'Yes'.

Enter the street address where you personally delivered the documents. Fill only if 'Personal Service' is 'Yes'.

Enter the city where you personally delivered the documents. Fill only if 'Personal Service' is 'Yes'.

Enter the state where you personally delivered the documents. Fill only if 'Personal Service' is 'Yes'.

Enter the ZIP code for the address where you personally delivered the documents. Fill only if 'Personal Service' is 'Yes'.

Enter the name of the business, agency, or other entity being served.

Enter the name of the person authorized to accept service for the business/entity and include the person’s job title.

Enter the full name of the person being served.

Enter the full name of the person who served the court papers.

Enter the phone number for the person who served the court papers.

Enter the street address of the person who served the court papers.

Enter the city where the server's address is located.

Enter the state where the server's address is located.

Enter the ZIP code for the server's address.

Enter the amount charged for serving the court papers.

If the server is a registered process server, enter the county where they are registered.

If the server is a registered process server, enter their process server registration number.

Check this box if you served the documents by substituted service (item 4b) instead of personal service.

Check this box if you left the papers with a competent adult (at least 18) at the person’s home who lives with the person served. Fill only if 'Substituted Service' is 'Yes'.

Check this box if you left the papers with an adult who seemed to be in charge at the place where the person served usually works. Fill only if 'Substituted Service' is 'Yes'.

Check this box if you left the papers with an adult who seemed to be in charge where the person served usually receives mail (or at a private post office box location) because there is no known physical address for the person served. Fill only if 'Substituted Service' is 'Yes'.

Enter the date you performed substituted service by giving the documents to the other adult. Fill only if 'Substituted Service' is 'Yes'.

Enter the time when you performed substituted service by giving the documents to the other adult. Fill only if 'Substituted Service' is 'Yes'.

Check this box if the substituted service time you entered was in the morning (a.m.). Fill only if 'Substituted Service' is 'Yes'.

Check this box if the substituted service time you entered was in the afternoon/evening (p.m.). Fill only if 'Substituted Service' is 'Yes'.

Enter the street address where you gave the documents to the other adult. Fill only if 'Substituted Service' is 'Yes'.

Enter the city where you gave the documents to the other adult. Fill only if 'Substituted Service' is 'Yes'.

Enter the state where you gave the documents to the other adult. Fill only if 'Substituted Service' is 'Yes'.

Enter the ZIP code for the location where you gave the documents to the other adult. Fill only if 'Substituted Service' is 'Yes'.