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Here is the text we could read:

SC-104A Proof of Mailing (Substituted Service) Case Number:

(cid:254) This form is attached to Form SC-104. Use this form ONLY if you mailed the documents in  1 and someone else

personally gave them to the person, business, or public entity served.

Notice to Server 
You must:
• Be at least 18 and not listed in this lawsuit.
• Fill out  1 – 6 of this form and attach it to Form SC-104.

1 Documents served by mail:

SC-100, Plaintiff’s Claim and ORDER to Go to Small Claims Court

SC-120, Defendant’s Claim and ORDER to Go to Small Claims Court 

a.

b.

c.

Other (specify):

2 Name and address of the person, business, or public entity served:

a.

 If you served a person, write the person’s name and address below:
Name:

Address: 

Street

City

State

Zip

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:

Business or Public Entity Name
Address: 

Street

Person Authorized for Service

Job Title

City

State

Zip

I put copies of the documents listed in  1 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 2 and mailed the envelope
by leaving it at (check one):

a.
b.

A U.S. Postal Service mail drop or
An office or business mail drop where I know the mail is picked up every day and deposited with the             
U.S. Postal Service.

b. From (city, state):

3

4

6

I mailed the envelope:
a. On (date):

5 My address is:

Date:

I declare, under penalty of perjury under California State law, that the information above is true and correct.

Type or print server s name

’

Server signs here after mailing

Judicial Council of California,  
Revised January 1, 2006, Optional Form  
Code of Civil Procedure, §§ 116.340, 415.20

www.courts.ca.gov

Proof of Mailing (Substituted Service) 
(Small Claims)

SC-104A, Page 1 of 1

Proof of Mailing (Substituted Service) (Small Claims)

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the California state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from selfhelp.courts.ca.gov (2023-03)
Page(s): 1
Fields(s): 24
Average fields per page: 24
Reading Level: Grade 7
LIST Grouping(s): Unknown

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

c_page_header_case_number_ft was SC-104A[0].Page1[0].Header[0].CaseNumber_ft[0] (0.57 conf)
c_page_list_lia_check_box was SC-104A[0].Page1[0].List1[0].Lia[0].CheckBox5[0] (0.40 conf)
c_page_list_lib_check_box was SC-104A[0].Page1[0].List1[0].Lib[0].CheckBox4[0] (0.40 conf)
c_page_list_lic_check_box was SC-104A[0].Page1[0].List1[0].Lic[0].CheckBox3[0] (0.40 conf)
c_page_list_lic_fill_text was SC-104A[0].Page1[0].List1[0].Lic[0].FillText20[0] (0.40 conf)
c_page_list_lia_fill_text__1 was SC-104A[0].Page1[0].List2[0].Lia[0].FillText19[0] (0.40 conf)
c_page_list_lia_person_adress was SC-104A[0].Page1[0].List2[0].Lia[0].SvcPersonAdress1[0] (0.40 conf)
c_page_list_lia_svc_person_city was SC-104A[0].Page1[0].List2[0].Lia[0].SvcPersonCity1[0] (0.40 conf)
c_page_list_lia_svc_person_state was SC-104A[0].Page1[0].List2[0].Lia[0].SvcPersonState1[0] (0.40 conf)
c_page_list_lia_svc_person_zip was SC-104A[0].Page1[0].List2[0].Lia[0].SvcPersonZip1[0] (0.40 conf)
page_list_lib_mailing_address was SC-104A[0].Page1[0].List2[0].Lib[0].AppellantMailingAddress[0] (0.40 conf)
page_list_lib_appellant_city was SC-104A[0].Page1[0].List2[0].Lib[0].AppellantMailingCity[0] (0.40 conf)
c_page_list_lib_appellant_mailing_zip was SC-104A[0].Page1[0].List2[0].Lib[0].AppellantMailingZip[0] (0.40 conf)
c_page_list_lib_person_adress was SC-104A[0].Page1[0].List2[0].Lib[0].SvcPersonAdress[0] (0.40 conf)
c_page_list_lib_svc_person_city was SC-104A[0].Page1[0].List2[0].Lib[0].SvcPersonCity[0] (0.40 conf)
c_page_list_lib_svc_person_state was SC-104A[0].Page1[0].List2[0].Lib[0].SvcPersonState[0] (0.40 conf)
c_page_list_lib_person_zip was SC-104A[0].Page1[0].List2[0].Lib[0].SvcPersonZip[0] (0.40 conf)
c_page_list_lia was SC-104A[0].Page1[0].List3[0].Lia[0].a[0] (0.39 conf)
c_page_list_lib was SC-104A[0].Page1[0].List3[0].Lib[0].a[0] (0.39 conf)
c_page_list_lia_fill_text__2 was SC-104A[0].Page1[0].List4[0].Lia[0].FillText7[0] (0.40 conf)
c_page_list_lib_fill_text was SC-104A[0].Page1[0].List4[0].Lib[0].FillText6[0] (0.40 conf)
c_page_list_item_fill_text was SC-104A[0].Page1[0].List5[0].Item5[0].FillText5[0] (0.40 conf)
c_page_sign_fill_text__1 was SC-104A[0].Page1[0].Sign[0].FillText40[0] (0.39 conf)
c_page_sign_fill_text__2 was SC-104A[0].Page1[0].Sign[0].FillText30[0] (0.39 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Proof of Mailing (Substituted Service) (Small Claims)

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Identified Data Fields:

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02