Free Acknowledgment of Receipt - District Court of Delaware - Delaware

* ri Case 1:05-cv-00915-KAJ Document 4 Filed 02/15/2006 Page 1 of 1
— ., I OFFICE OF THE CLERK
UNITED STATES DISTRICT COURT _
_ ~ · DISTRICT OF DELAWARE
Peter T. Dalleo LOCKBOX 18 `
CLERK F 844 me smear
‘ I us. comzrnousa
WILMINGTON, DELAWARE 19801
(am) 573-6170
RE: c.A.# ~ O 5~·CllE5(l CASE CAPTION: ‘ Mgfflt B V. AYljlClZ€>`m - Gem
I ACKNOVVLEDGIVIENT OF RECEIPT FOR F.R.Civ.P. 4
I hereby acknowledge receipt of a copy of Rule 4 (Summons) of the Federal
Rules of Civil Procedure, and understand that it is my responsibility to make service of
_ process on defendants in accordance with this rule. .
_ . E ‘, _; _ _ I q
Date Received · é. /5 ZOO 6 Signed. ,
by Plaintiff: Pro Se Plaintiff
Date Received al \ 5 Q Ma Signed: S Q S
I by Clerk’s office: as " Deputy Clerk
Note: If you received Federal Rule 4 by mail, please sign this receipt and return it to: _ I
Clerk
U.S. District Court "
844 N. King Street If applicable, Rule 4 mailed to plaintiff:
Lockbox 18 I ‘ g
Wilmington, DE 19801 E E IDD .
g D e ailed ‘
I - By Deputy Clerk
cc: Docketing Clerk ‘
‘ wp\fo:·ms\m1e4xeceipt 2-D4 i