Free Summons Returned Executed - District Court of Connecticut - Connecticut

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I ase T - - 712-WWE Document 43 Filed O3/08/2004 Page 1 of 3
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I UNITED STATES DISTRICT COURT l F I E D I
I DISTRICT OF CONNECTICUT .
...-............................................................ X
I GERTRUDE BAYoNNE, I lllllli MAH — 8 ID l2= 3 3 I
I Plaintiff(s), [IIge{c] l`§pI` {M13 ICISIIYHQZQWI/WE) I
I _ BRIDGEPIIIQI CS`!
, -aga1nst- AFFIDAVIT OF SERVICE
I PITNEY BOWES INC., ET AL., I
I Defendant(s). I
I ————-—-—-—-—-——-———--———--—---——---——---—-------------—--------- X I
I STATE OF NEW YORK )
I SS.2 I
I COUNTY OF ROCKLAND )
DAVID KSIAZEK, being duly sworn, deposes and says that he is over the age of eighteen I
years, is employed by the attorney service, D.L.S., INC., and is not a party to this action.
That on the 4TH day of February, 2004, at approximately 2:35 PM, deponent served a true
copy of the SUMMONS, ORDER ON PRETRIAL DEADLINES, RULING ON REVISED MOTION
TO AMEND AND REVISED AMENDED COMPLAINT upon THE PITNEY BOWES INC LONG
TERM DISABILITY PLAN at l Elmcroft Road, Stamford, Connecticut 06926, by personally delivering
and leaving the same with JENNIFER SANDOBAL, who informed deponent that she is an legal assistant I
authorized by THE PITNEY BOWES INC LONG TERM DISABILITY PLAN to receive service at that
address. I
JENNIFER SANDOBAL is a white female, approximately 26 years of age, stands I
approximately 5 feet 6 inches tall, weighs approximately 150 pounds with brown hair and blue eyes. I
l R.-- '.-. { I
DAVID KSIAZE 0974523 I
I
Sworn to b_ or me this
lim day o e uary, 2004 I
ALAN DEMOVSKY '
/L Notary Public, State ot New York I
Qualltlod In Rockland County I
No. 31-4812156 / ,
NOT UBL C Cort. Fund In New York Bounty -\
Commission Expires att ZM =
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AO 440 nov. wise Summons Ina clvll Action g ___ __ ____ _;_:__=_T_;_=_=_; :_:_=_:____e___
Case3:O3—cv-OO "" '• ' ‘ ‘ ' ' " "
4 ~ _; 4. Qtitmtsh States Erstrrct Gluurt
I
4 DISTRICT OF
4 CONNECTICUT
4 GERTRUDE BAYONNE,
7 Plaintiff suMMoNs IN A civu. cAsE
I y_ CASE NUMBER 3:O3Cv0712(wwE)
PITNEY BOWES, INC A THE PITNEY I
BOWES INC LONG TERM DISABILITY PLAN,
THE PITNEY BONES INC LONG TERM 4
4 DISABILITY PLAN ADMINISTRATOR A THE
PITNEY BOWES INC DISABILITY DEPARTMENT, 4
Defendants
I
TOC (Name and address of defendant)
The Pitney Bowes Inc Long
Term Disability Plan
MSC O 7 — 0 0
One Elmcroft Road
Stamford, CT 06926
YOU ARE HEREBY SUMMONED ooo required to senxe upon i=·l.AiNrll=l=·s Arrosuar (name ooo address)
Mark P. CArey I I
Carey & Associates PC
. 71 Old Post Road, Suite One
‘ Southport, CT 06890
(203) 255-4150 4
. . I
an answer to the complaint which is herewith served upon you, within 2 0 days after service ofthis 4
summons upon you, exclusive of the day of service. if you fail to do so, judgment by defaultwill be taken against you forthe relief
demanded inthe complaint. You must also file your answer with the Clerk ofthis Court within a reasonable period of time after
service. _
KEVIN? It iiovrz / 9 A
CLERK DATE
(sv) ospurv cl.&si< I



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I Case 3:03-cv-00712-WWE Document 43 Filed O3/08/20 9
\ AO 44p (Rev. 10/93 Summcns In a Civil Action
l l s ‘* RETURN OF SERVICE

` Service of the Summons and Complaint was made by mel
\ Check one box below to indicate a ropriare method of service
{ [2] Served personally upon the defendant. Place where served:

l E] Left copies thereof at the defertdant's dwelling house or usual place of abode with a_ person of suitable age
and discretion then residing therein. l
Name of person with whom the summons and complaint were left: l

l
I [I] Returned unexecuted: _
I;] Other (specify).-
|
‘—"—·······———·———»-———·—··——————————— l
STATEMENT OF SERVICE FEES l ,
l
DECLARATION OF SERVER
l declare under penalty of perjury under the laws of the United States of America that the foregoing
information contained ln the Return of Service and Statement of Service Fees is true and correct. I

Executed on —.—________ ..._ .._ ...._. .,.._..- . R
Date Signature of Server
Address of Server \
(1) As to who may serve a summons see Rule 4 of the Federal Rules ot Civil Procedure. I