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Index No.
Case Number:
SC-104A
Proof of Mailing (Substituted
: Calendar No. Service)
: JUDICIAL SUBPOENA Plaintiff(s) 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-against- business, or public entity served. person, :
Notice to Server
: You must: • Be at least 18 and not listed in this lawsuit. : 1 – 6 of this form and attach it to Form SC-104. • Fill out Defendant(s) : . . . . . . . . . . . . . . . . . . . by . . . . 1 Documents .served . . . .mail:. . . . . . . . . . . . . . . . . . . . . . . . . .
a. SC-100, Plaintiff’s Claim and ORDER to Go to Small Claims Court b. SC-120, Defendant’s Claim and ORDER to Go to Small Claims Court THE PEOPLE OF THE STATE OF NEW YORK c. Other (specify):
TO
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: GREETINGS: Name: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Address: , the Honorable at the Court Street City State Zip located at County ofserved a business or public entity, write the name and address of the business or public entity, the person b. If you in room , on the day of , , at o'clock in the noon, and at any recessed authorized for service, and that person’s job title: 20 or adjourned date, to testify and give evidence as a witness in this action on the part of the
Business or Public Entity Name Person Authorized for Service Job Title
3
Address: Street City State Zip Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on of the documents listed in 1 was issued for a maximum penalty of $50 and all damages sustained as a I put copies whose behalf this subpoena above in an envelope, sealed the envelope, and put first-class prepaid result of on it. failure to comply. postage your I addressed the envelope to the person, business, or public entity listed in 2 and mailed the envelope by leaving it at (check one): Witness, Honorable , one of the Justices of the a. A U.S. Postal Service mail drop or Court in County, day of , 20 b. An office or business mail drop where I know the mail is picked up every day and deposited with the U.S. Postal Service.
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I mailed the envelope: a. On (date): b. From (city, state):
(Attorney must sign above and type name below)
5 6
My address is:
Attorney(s) for
I declare, under penalty of perjury under California State law, that the information above is true and correct. Date:
Office and P.O. Address
Type or print server’s name
Judicial Council of California, www.courtinfo.ca.gov Revised January 1, 2006, Optional Form Code of Civil Procedure, §§ 116.340, 415.20
Telephone No.: Server signs here after mailing Facsimile No.: E-Mail Address: Mobile Tel. No.: Proof of Mailing (Substituted Service)
(Small Claims)
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