Free Summons Returned Executed - District Court of Connecticut - Connecticut

Case 3:03-cv-00712-WWE Document 42 Filed O3/08/2004 Page 1 of 3 I
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GERTRUDE BAYONNE, _ _ I
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Plamtiff(s), Iiidéé QW? H2 [WWE) I
—against— AFFIDAVIT OF SERVICE
PITNEY BOWES INC., ET AL., I
Defendant(s). I
............—................................................... X
STATE OF NEW YORK )
S.S.:
COUNTY OF ROCKLANI) )
DAVID KSIAZEK, being duly sworn, dcposes and says that he is over the age of eighteen
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 ofthe SUMMONS, ORDER ON PRETRIAL DEADLINES, RULING ON REVISED MOTION
TO AMEND AND REVISED AMENDED COMPLAINT upon PITNEY BOWES INC DISABILITY
DEPARTMENT at l Elnicroft Road, Stamford, Connecticut 06926, by personally delivering and leaving I
the same with JENNIFER SANDOBAL, who informed deponent that she is an legal assistant authorized
by PITNEY BOWES INC DISABILITY DEPARTMENT to receive service at that address. I
JENNIFER SANDOBAL is a white female, approximately 26 years of age, stands
approximately 5 feet 6 inches tall, weighs approximately 150 pounds with brown hair and blue eyes. I
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DAVH) KSIAZE 974523
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Sworn to before his I
ll"` day of Febru 2004 I
" ALAN DEMOVSKY 5
Notary Public, State ct New York I
Qualltlod In Ittookliinglctlounllt
No. 31-48121
NOTARY PUIBLIC cart. Filed In New York Count! <
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AO 440 $Flev. 10/93) Summons In a Civil Action l
Case 3:03-cv-OO 1 — 0cu men i {
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. — Qbtrtrtzh States Etairtci (llourt
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DISTRICT OF i
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CONNECTICUT i
GERTRUDE BAY0NNE· SUMMONS IN A CIVIL CASE
Plaintiff
v· - CASENUMBEW 3:O3cv0712(NNE)
PITNEY BONES INC, & THE PITNEY
BONES INC LONG TERM DISABILITY PLAN,
THE PITNEY BONES INC LONG TERM DISABILITY
PLAN ADMINISTRATOR, THE PITNEY BONES INC
DISABILITY DEPARTMENT,
Defendants
TOC (Name and address of defendant) {
PITNEY BONES INC DISABILITY DEPARTMENT `
MSC 07-00
One Elmcroft Road
Stamford, CT 06926
YOU ARE HEREBY SUM MONED and required to serve upon PLAlNTIFF’S ATTORNEY (name and address)
Mark P. Carey i
Carey & Associates PC i
71 Old Post Road, Suite One )
Southport, CT 06890
(203) 255-4150 i
an answerto the complaint which is herewith served upon you, within 2 O days after service ofthis
summons upon you, exclusive ofthe day of service. if you fail to do so, judgment by default will be taken against you for the relief _
demanded in the complaint. You must also file your answer with the Clerk of this Court within a reasonable period or time after
service. i
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Case 3:03-cv-00712-WWE Document 42 Filed O3/08/2004 Page 3 of 3
~ · AU 440 {Rev. 10/93 Summons In a Civil Actlon l
- ‘ RETURN OF SERVICE l
S6l’VlC9 of ING SUTTIFTIODS BHG Complaint WGS l’l’\Bd8 by ITWB1
"‘”E °"” "“E“ —
Check one box below to indicate a ropriate method of service
D Served personally upon the defendant. Place where served: g
““—““"—““——*— l
[I] Left copies thereof at the defendants 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:
““"“—‘“‘—‘_"‘—‘———·—··r—·~·—~·~ l
D Returned UFISXBCUIBCIZ l
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s·rA1·aManT oi= saavica Fees l
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l declare under penalty of perjury under the laws of the United States of America that the foregoing
information contained in the Return of Service and Statement of Service Fees is true and correct.
Executed on K
Date Signature of Server
Address of Server
(1) As to who may serve a summons see Flute 4 ol the Federal Rules cl Civil Procedure.