California · Official court form

Fill out Proof of Service SC‑104 yourself

SC-104 · Revised January 1, 2009 · Judicial Council of California

Proof of Service (Small Claims). You type every answer. We put your words, exactly as you typed them, into the official form and make a PDF on your device.

This is a free tool. We are not lawyers and this is not legal advice. You fill in and sign the form yourself.

We are not connected with the California courts. The person who served the papers (the server) signs this form, not you, and signs it under penalty of perjury. The PDF is the Judicial Council’s form SC-104, Revised January 1, 2009, with its text unchanged.

Before you start, read SC-104B, What Is “Proof of Service”? and the court’s page Serve your small claims forms.

Step 1 of 7

Court and case

The box on the right of page 1, and the case name and number at the top of page 2. Copy them from the court-stamped claim you are serving.

Help with this step

The clerk wrote the case number and the trial (hearing) date, time and department on page 1 of the claim when it was filed. The court’s guide says the person who asked for service usually fills in this top part, and the server fills in how, when and where the papers were served. Serve your small claims forms (California Courts).

The words “Superior Court of California, County of” are already printed above this box.

As on the claim, like 8:30 a.m.

Top of page 2