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

Case 1 :07-cv-00078-JJF Document 5 Filed O3/O2/2007 Page 1 of 3
=¤:sAO 440 (Rev. 8/Ol) Surnmons in a Civil Action
UNITED STATES DISTRICT COURT
District of Delaware
_ . SUMMONS IN A CIVIL CASE
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YOU ARE HEREBY SUl\/[MONED and required to serve on PLAINTIFFS ATTORNEY (name and address)
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an answer to the complaint which is served on you with this summons, within days after service
of this summons on you, exclusive of the day 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 tiled with the
Clerk of this Court within a reasonable period of time after service.
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(By) DEPUTY CLERK

Case 1 :07-cv-00078-JJF Document 5 Filed O3/O2/2007 Page 2 of 3
¤¤AO 440 (Rev. 8/Ol) Summons in a Civil Action
RETURN OF SERVICE
DATE
Service of the Summons and complaint was made by mem
NAME OF SERVER (PRINT ) , _ _ TITLE
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Check one box below to indicate a » ro riate method 0 service
El Served personally upon the defendant. Place where served:
1] Left copies thereof at the defendant’s 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:
El Returned unexecuted:
D Ot.her (specify): Ag:e_?; /j[ lg gl I
STATEMENT OF SERVICE FEES
TRAVEL SERVICES TOTAL
I DECLARATION SERVER
· I declare under penalty of perjury under the laws of the United States of America that the foregoing infomation
contained in the Retum of Service and Statement of Service Fees is true and correct.
Executedon 2 TIRE"` D7 `
» Date Signature of Server
Address afServer
(1) As to who may serve a summons see Rule 4 of the Federal Rules of Civil Procedure.

Case 1 :07-cv-OOO78-JJF Document 5 Filed O3/O2/2007 Page 3 of 3
SENDER; cQMpg_5TE rH;5 SECUON COMPLETE TI-IIS SECTION ON DELIVERY
I Complete Items 1, 2, and 3. Also complete A- 9*9 at /
item 4 if Restricted Delivery is desired. xl D Agent
I Print your name and address on the reverse EI Addresses
so that we can return the care to you. _ wed by ( Pmed Name,) C_ Dm 0, Dam, _
I Attach this card to the back of the msilpleoe, - I !
or on the front if space permits. or r "
_ _ D. is delivery address different from item T'? E] Yes
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4. Restricted Delivery? (Extm Fee) I] vas
2. Article Number
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PS Form 381 'I, February 2004 Domestic Ftetum Receipt 102595-02-M-1540 5
U.S. Postal Service
H CERTIFIED IVIAILI., RECEIPT
L.-, (Domestic MaII OnIy; No Insurance Ce verage Prowded)
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