Free Waiver of Service Unexecuted - District Court of Connecticut - Connecticut

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' Case 3:03-cv-00645-CFD Document 11PR0l2Ed O3/08/i;)O4 Pag
us. Department of Justice $S REF R’. I AND RETURN ,
. . See Instructions for Servtce of Process by the US. Marshal
I UH1I€d States Marshals SCTVICE on the reverse of this form.
PLAINTIFF counr Igin. ‘
I ,.I 0.3/E °QIU€/A/°\ [ 3,*03 I FD-- 60276 '
I DEFENDANT TYPE OF PROCESS
I QRIAIQUQKI I—le.ct G2 (QOD/2g1”G&.tt9”L. VII it · "‘ •· I ; I
_ SERVE NAME OF INDIVIDUAL, COMPANY, CORPORATION, ETC., TO SERVE OR DESCRIPTION OF PROPERTY TO SEIZE OR CONDEMN l
I I l I
I » (A}/7•€°O€#U 2*-/G (/7`U2, )Q0lD»€Z6ZC/&’Z.. CCP CA/ RII~ I~I—II use-~ ‘
I ADDRESS (Street or RFD, Apartment No., City, State and ZIP Code) B I{i._. ` ' I
I 1-;;; I
I AT 00 Acre;/¢A»o Adi cAOJ)4f2'2é’@ cx. Q6 /0 I
I SEND NOTICE OF SERVICE COPY TO REQUESTER AT NAME AND ADDRESS BELOW: l
I —————— -—· ————————————-—————-—— --—- —-—— ·—-—-l Number of process to be I
I d ` It h' F - 285 '
I I # serve wit t IS arm Z I
I C Ct I Number of parties to be
. · Iserved in this case
I QUO bI€I;°G·I’I(-·•4'*JD I __ _ {EE I
I MI ICheck for service OQ "‘ J I
I ——-—-—--———-———-——--——--—---—---—----- Im U-S-A- $3; I, ``I. fggjt I
I SPECIAL INSTRUCTIONS OR OTHER INFORMATION THAT WILL ASSIST IN EXPEDITING SERVICE (Include Business d Alte aterivaiidljesses, All
Telephone Numbers, and Estimated Times Available For Service): "t'· ul __,I ` .. I =`I
I E Q-; · $7;; this
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·-Q.; · `A I T
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I I ,L)DIUJZI.)U/-\L CA/OACI J / ~!#'€’O III I-I I,.I
_,,,.I £.—•·~
Signature of Attomey or other Originator requesting service on behalf of: Q4LA[NTIFF TELEPHONE NUMBER DATE
xi QQ > I] oesanonnr I5 {/G; O3 l
SPACE BELOW FOR USE OF U.S. MARSHAL ONLY —DO NOT WRITE BELOW THIS LINE
I acknowledge receipt for the total Total Process District District Signature of Authorized USMS Deputy or Clerk Date
number of process indicated. of Origin to Serve
(Sign only tirst USM 285 if more J I Ld. / .
than one USM 285 is submitted) No. ji No. ii ` I ._;__ ._._
I hereby certify and return that I [I have personally served, I] have legal evidence of service. I3 have executed as shown in "Retnarks", the process described I
on the individual, company, corporation, etc., at the address shown above or on the individual, company. corporation, etc., shown at the address inserted below. I
lj I hereby certify and netum that I am unable to locate the individual, company, corporation, etc., named above (See remarks below) I
Name and title of individual served (if not shown above) A pgrggn gf suitable age and dig- I
lj cretion then residing in the defendants
usual place of abode.
Address (complete only if different than shown above) Date of Scrvicc Time am I
. pm ’
Signature of U.S. Marshal or Deputy
{ I
Service Fee Total Mileage Charges Forwarding Fee Total Charges Advance Deposits Amount owed to U.S. Marshal or Amount of Refund I I
(including endeavors) I
REMARKS:
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