Free Request for Waiver of Service - District Court of Delaware - Delaware

Case 1:04-cv-00105-JJF Document 33 Filed 08/22/2007 Paget of 3
IN THE DISTRICT COURT FOR THE DISTRICT OF DELAWARE
UNITED STATE OF AMERICA, AND THE :
STATE OF DELAWARE, ex rel. :
WALTER T. DECYK, III, L.P.N. ; /
vs. Q /
: CIVIL ACTIO NO.
: 04-105-JJF
GREEN ACRES HEALTH SYSTEMS, INC. : FILED I CAMEM
ALLEN SEGA L, PRESIDENT And GREEN : AND I DER SEAL
VALLEY PAVILION; etal. : ».
DEFENDANTS ; F Nj .
REQUEST FOR WAIVER OF SERVICE
OF SUMIVIONS, PURSUANT TO F.R. CIV. P. 4gd]
TO: GREEN ACRES HEALTH SYSTEMS
GREEN VALLEY PAVILION
ATTN: ALLEN SEGAL, PRESIDENT
C/O: W. CRAIG KNAUP, ESQUIRE -
Law Office of W. Craig Knaup ·
Station House, 900 Haddon Ave., Suite 206
Collingswood, N.J. 08108 I
Plaintiff Walter T. Dccyk, III, L.P.N., by and through his attorneys, Requests
that Defendant Green Acres Health Systems, and Green Valley Pavilion, by and
through their attorney, waive the service of summons, and avers as follows;
A lawsuit has been commenced against you, or the entity on whose behalf
you are addressed. A copy ofthe complaint is attached to this notice. It has been
liled in the United States District Court for the District of Delaware and has been
assigned docket number O4-105-JJF. I
This is not a formal summons or notification from the court, but rather my
l
1 Q

I" Case 1:04-cv-00105-JJF Document 33 Filed 08/22/2007 Page 2 of 3
request that you sign and return the enclosed waiver of service in order to save the
cost ofserving you with ajudicial summons and an additional copy ofthe
complaint. The cost of service will be avoided ifl receive a signed copy ofthe
waiver within thirty (30) days after the date designated below as the date on which
this Notice and Request is sent. I enclose a stamped and addressed envelope for
your use. An extra copy ofthe waiver is also attached for your records.
lf you comply with this request and return the signed waiver, it will be filed
with the court and no summons will be served on you. The action will then
proceed as ifyou had been served on the date the waiver is filed, except that you
will not be obligated to answer the complaint before 60 days from the date
designated below as the date on which this notice is sent (or 90 days from that date
if your address is not in any judicial district ofthe United States).
If you do not return the signed waiver within the time indicated, I will take
appropriate steps to effect formal service in a manner authorized by the Federal
Rules of Civil Procedure and will then, to the extent authorized by those Rules, ask
the court to require you (or the party on whose behalf you are addressed) to pay the
full costs ofsuch service. In that connection, please read the statement concerning -
the duty ofparties to waive the service of summons, which is set forth at the foot of l
the waiver form.
I affirm that this request is being sent to you on behalf ofthe plaintiff, this
12m day oflune, 2007.
August 17,2007 a·
CHAN E. BUTLER V
1224 North King Street
Wilmington, Delaware 19801
(302) 655-4100
Attorney for Defendant

Case 1:04-cv-00105-JJF Document 33 Filed 08/22/2007 Page 3 of 3
CERTIFICATE OF SERVICE
I, Charles E. Butler, local counsel for Plaintiff Walter T. Decyk, III, hereby certify
that I caused to be served, by first class U.S. Mail, postage prepaid, a Request for Waiver
of Service of Summons, upon the following:
. GREEN ACRES HEALTH SYSTEMS
GREEN VALLEY PAVILION
ATTN: ALLEN SEGAL, PRESIDENT
C/O; W. CRAIG KNAUP, ESQUIRE
Law Office of W. Craig Knaup, P.C.
Station House, 900 Haddon Ave., Suite 206
Collingswood, NJ. 08l08
1 , - i`` i
August 17, 2007 A- ’ ·
CHARLES E. BUTLER
1224 North King Street
Wilmington, Delaware 19801
(302) 655-4100
Email: [email protected]
Attorney for Defendant