Fillable Form or document served: SC-112A Proof of Service (California)

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Form or document served: SC-112A Proof of Service (California)

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Proof of Service by Mail
(Small Claims)
Judicial Council of California, www.courts.ca.gov
New July 1, 2010, Optional Form
Cal. Rules of Court, rule 3.2107
SC-112A
SC-112A
Proof of Service by Mail
This form is attached to the document checked in
Server s information
Form or document served
a.
b.
c.
d.
e.
f.
g.
(specify):
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.
I placed copies of the document checked in
b.
Name of party served Mailing address on the envelope
I placed each envelope in the mail, with postage paid, at
c.
I declare under penalty of perjury under the laws of the State of California that the information above is true and correct.
See instructions on other side.
Name: Phone:
Street or mailing address:
City: State: Zip:
Check here if you are a registered process server, and write:
County where registered: Registration #:
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
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.
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.
On (date of mailing):
(city and state of mailing):
Date:
Type or print server s name
1
2
3
þ
2
2
Server signs here
Case Number:
below.
addressed as follows:
and an unsigned copy of this page in a sealed envelope,
’
’
’
Instructions for Proof of Service by Mail
(Small Claims)
New July 1, 2010
SC-112A
Instructions for Form SC-112A, Proof of Service by Mail
(This page is not part of the Proof of Service and does not need to be copied, served, or filed.)
Form SC-112A can be used to show the court that these documents
were served by mail:
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 documents that are allowed to be served by mail
Form SC-112A cannot be used to prove service of these forms:
Form SC-100, Plaintiff’s Claim and ORDER to Go to Small Claims Court
Form SC-120, Defendant’s Claim and ORDER to Go to Small Claims Court
File these papers with the small claims court clerk:
The original of each document served, with
The signed, original Proof of Service by Mail attached
Ask the server to:
Fill out the remainder of the Form SC-112A.
Mail each party to be served:
An unsigned copy of the completed Form SC-112A and
The document to be served (checked in Item ).
Sign a separate Form SC-112A for each document served, and give it to back you.
Give the server:
The partially completed Form SC-112A
One copy of the document to be served for each party to be served
*Prepare a separate Form SC-112A for each document to be served.
Prepare Form SC-112A by filling in:
The case number
The document to be served, in item
*
The names and addresses of the parties to be served, in item
The server (the person who will do the mailing):
Must not be a party (plaintiff or defendant) in the case
May be a friend, relative, co-worker, or other helpful person
Must be 18 or older
Must live or work in the county where the mailing takes place
Follow these steps to use Form SC-112A:
For information about serving these forms, see Form SC-104, Proof of Service, and
Form SC-104B, What Is “Proof of Service”?
Or go to “County-Specific Court Information” at www.courtinfo.ca.gov/selfhelp/smallclaims.
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Need help?
For free help, contact your county’s Small Claims Advisor:
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Form or document served: SC-112A Proof of Service (California)

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Completed 19 May 2021

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