Free Summons Returned Executed - District Court of Delaware - Delaware

Case 1 :07-cv-00066-G MS Document 16 Filed 04/20/2007 Page 1 of 1
*5;:*40 449-{ Rev. B/D1) Summons in a Civil Action
RETURN OF SERVICE { .i_; _1 [per -_=_ __
DATE
Service of the Summons and complaint was made by mem 3 _ Q
NAME gr sgrtvsa (PRINT) TITLE
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jh Served personally upon the delerrdant. Place where served:
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lll Left copies thereof at the defendanfs dwelling house or usual place of abode with a person of suitable age and
discretion then residing therein.
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Name of person with whom the summons and complaint were left: Q Z
. El Retumed unexecuted:
El Other (specify):
STATEMENT OF SERVICE FEES
TRAVEL SERVICES TOTAL
DECLARATION OF SERVER
I declare under penalty of perjury under the laws of the United States of America that the tbregoing information
contained in the Return of Service and Statement of Service Fees is true and correct.
Executed on 3 {4 2 (
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infomation Retrietrai Services
_ P.O. BOX 268
r eeoneerovxn, DE taser
Adrlmrs of Sr·rve1·‘
(1) As to who may serve a srrmmo s see Rule 4 of the Federal Rules of Civil Procedure.