Free Summons Returned Executed - District Court of Delaware - Delaware

Case 1 :05-cv—00873-GIVIS Document 2 Filed 12/28/2005 Page 1 of 2
AO 440 (Rev. 8/Ol) Summons in a Civil Action
RETURN OF SERVICE
Service of the Summons and complaint was made by mel DATE December 20, 2005
NAME or s12RvER(PR1Nn Melissa N. Flores rirra Paralegal
Check one box below to indicate appropriate method of service
Q Served personally upon the defendant. Place where served:
Q 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:
Q Returned unexecuted:
K Other (specify): Certified U.S. Mail , Return Receipt Requested, addressed to:
Larry Pavey
6720 Colonel Holcomb Drive,
Cr stal Lake, IL 60012-1091
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
foregoing infonnation contained in the Retum of Service and Statement of Service Fees is true and correct.
Executed on 12/28/05 Z 2 2;,éj(gAG,` {Z; xgé
Date Signatu of Server
1000 West Street, Suite 1410, Wilmington, DE 19801
Address of Server
I As to who may serve a summons see Rule 4 of the Federal Rules of Civil Procedure.

Case 1 :05-cv—00873-GIVIS Document 2 Filed 12/28/2005 Page 2 of 2
SENDER; (;OMp[_ETE T;-{js 5ECT[ON COMPLETE THIS SECTION ON DELIVERY
I Complete items 1, 2, and 3. Also complete A $*9¤¤*¤'° _
item 4 if Restricted Delivery is desired. X _ V , K. _` a D AQ€¤'*
I Print your name and address on the reverse - ~~ ...» ·'. **.·=-as ' U Addfesseé
S° that WP can return the card t° y°u·_ _ B. Received by (Printed Name) C. Date of Delivery
I Attach this card to the back of the mailpiece, /),*2 ct,L*I
or on the front if space permits. ·
_ D. Is delivery address different from item 1? U YGS
1‘ Amcle Addressed t°: 7 7 7 If YES, enter delivery address below: ¤ No
LARRY PAVEY
6720 Colonel Holcomb Drive
Crystal Lake, Illinois 60012-1091
3. nrioe Type C " ~ ‘ W
Certified Mall E1 Express Mall
D Registered handise
I] Insured Mall D C.O.D.
4. Restricted Delivery? (Extra Fee) [1 Yes
2. Article Number
(r,,,,Sf.,,,,,,,,,S,,,,,,c,,,,,,,,,0 ?IZll]l·l ].35lZl EIEIIZIE 1551; BBL.3
PS Form 381 1, February 2004 Domestic Return Receipt 102595-02-M-1540