Free Return of Service Executed - District Court of Delaware - Delaware

Case 1 :07-cv—OOO92-JJF Document 3 Filed O2/27/2007 Page 1 of 2
QQAO 440 (Rev S/0E) Summons in a Civil Action
, UNITED STATES DISTRICT CoURT
District of Delaware
IOANN KAYEA,
SUMMONS IN A CIVIL CASE
Plaintiff`,
CASE NUMBER: {jj; . zi
v
THE PRUDENIIAL INSURANCE
COMPANY OF AMERICA, a foreign
insurance company,
Defendant
IOS (Name & Address of Defendant) ,
Prudential Insurance Company of America
c/o Insurance Cornrnissioner of the
State of Delaware
841 Silverlake Boulevard
Dover, DE 19904-2465
pursuant to 18 @ Q. § 524 & 525 -
YOU ARE HEREBY SUMMONED and required to serve on PLAINIIPFS AI"I ORNEY (name and address)
William D. Fletcher, Ir. ·
Bar ID #362 ‘
Schmittinger & Rodriguez, P A.
414 S. State Street
P O. Box 497
Dover, DE 19903-0497
an answer to the complaint which is served on you with this summons, with 20 days after service of this
summons on you, exclusive of the date of service If you fail to do so, judgment by default will be taken against _
you for the relief demanded in the complaint. Any answer that you serve on the parties to this action must be filed
with the Clerk of this Court within a reasonable period of time after service
PETER I, DAILEG g Q gag? I
CLERK DATE
(By) DEPUTY CLERK

Case 1 :07-cv—OOO92-JJF Document 3 Filed O2/27/2007 Page 2 of 2
T- RETURN OF SERVICE
Service of the Summons and complaint was made by mem DATE 2
NAME OF SERVER (Prmvr) g nyu; fl —
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Check arte ban; biaw to indicate appropriate method of service · _ `
Served personally upon the defendant. Place where served: -
Left copies thereof at the defendants dwelling house or usual place of abode with a person of suitable age
and discretion then residing therein
Name of person with whom the summons and complaint were left:
Returned unexecuted:
Other (specify): Ziff? J ' v wj
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STATENIENT OF SERVICE ’ ES
TRAVEL. ,i"i ~»~·”'"f— SERVICES l TOTAL. _ - 'I iiiii i Q
wv/R" DECLARATION OF SERVER /,/'
I declare under penalty of perjury under the laws of the United States of America that the foregoing
information contained in the Return of Service and Statement of Service Fees is true and correct
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Date Signature of Server __ ,
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(l) As to who may serve a summons see Rule 4 ofthe Federal Rules of Civil Procedure i