Free Waiver of Service Executed - District Court of Delaware - Delaware

Case 1:04-cv—01385-Gl\/IS Document 14 Filed 10/24/2005 Page 1 of 2
U S De artment of Justice PROCESS RECEH I AND REIUWI
' _ ` p ” _ See Instructions for "Service of Process by the U.S. Marshal"
United States Marshals Service on ttm reverse Ormts ram.

PLAINTIFF ,— _ , COURT CASE NUMBER
at ' A A A H A 0
DEEENDANT TYPEfOF PROCESS
7 A F ” .. 5 .
/-.5 . l4 » ¢ Z /*5
SERVE NAME or tNDtvtDuAt., COMPANY, CORPORATION, ETc.. TO SERVE OR DESCRIPTION or PROPERTY TO SEt2E OR coNoEMN
LZQ qgagggig
* ADDRESS (Street or RFD, Apartment No., Cit State a · ZIP Code)
. t / / A y [ s g . ..
AT - G. / 1,4....-4._a.. - A J at 1..4 V. ' »
SEND NOTICE OF sERvtcE c0Pv TO REQUESTER AT NAME AND ADDRESS BELOW. · (
-—————-—---—---—-—-—-— - -----—---———-— I Num _ of process t be I
_ ( I served with this Form — 285
. ZM Aj .» 5?.2'#$" _ p
‘ T IN be f rt` t b 5*
I' ‘ I, IIIUI IOPZIICSOC
( 54 Iserved in this case
r
I ' ,7 lCheck for service
__________ » T ____ 74 _____ ___ __ ________ Ion U.S.A.
SPECIAL INSTRUCTIONS OR OTHER INFORMATION THAT WILL ASSIST IN EXPEDITING SERVICE (Include Business and Altemate Addresses, All
Telephone Numbers, and Estimated Times Available For Service): if
E 5 mj Pe
{ > i J . V , _,· V. ,
if j iacdé/D2; gy ’7
§·.P-—_ , ' 47 @9 @#/77 Q-
·‘ // ..! "/ — .4/[ ' C .
Sign ur of Atto y or other Originator rc esting s rv` · on bchalfot`2 TELEPHONE NUMBER DATE
. / /_ / XPLAINTIFF r -
, / Q, ‘ { · ,g Et DEFENDANT
I - T
PACE BELOW FOR USE F 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 ot` process indicated. of Origin to Serve
(Sign only first USM 285 if more &, ?\ ""[` W
than one USM 285 is submitted) No. ___ No. {W é;._. %.__&.__.._.._,4. ._;.
I hereby certify and rctum that I I] have personally served. Z have legal evidence of service. El have executed as shown in "Remarlcs". the process described
on the individual. company. corporation. etc.. at the address shown above or on thc individual. company, corporation, ctc.. shown at the address inserted below.
lj I hereby certify and return that I am unable to locate the individual, company. corporation. ctc., named above (See remarks below)
Name and title of individual served (if not shown above) A person of suitable age and dis»
. .- . »{ ....—..—..- D. , . _ LL __ Q cretion then residing in the defendanfs
'f _ usual place ol` abode.
Address (complete only ifditlerent than shown above) I,;_,,__j_;_____T_ _ Date of Service Time am
= . . . . i f I 0/ r b/ (l` Pm
: I . . I
Q’ ' " ` Signature f U S. Marshal or Deputy
t t été
Service Fee Total Mileage Charges Forwarding Fcle Total Chqi;g s ` ’ De psits Amount owed to U.S. Marshal or Amount of Refund
(including endeavors) =-· -—--·- `
REMARKS;
Uqgkt \;2.f` I/Lp'l.J..M/\.1,0l
m°gEE}g;*gNS 1. CLERK or THE coURT “”“’ ”S’“·”5 me '”'*’”>

Case 1:04-cv—01385-Gl\/IS Document 14 Filed 10/24/2005 Ffage 2 of 2
I 1. 1 » -
tt tier 11 1.,/

RE-TURN OF WAIVER (ll? SERVICIE OF SlZY\iTvlt)i` i LlCi{llO\\/iC(igC l`€C€lp1 Ofililti l't2L]llCS°[ Iiléll i CZ11l \\»'21i\/C St21'\'1CC t1'iiS111ll1llO11S lll tilt) 1'11L11lt‘1‘ ttl
CA. No.04—l385 in the United States District ofDelaware. l have also received a copy ol-1l`1t‘
Ctlllllliflllll ill tilC 2.1CtlOll. two CO[)l€S of iiliS i“OfIll, llCO17y Olililtl O1`(iC1' Ol`lil(` (`t>1l1`l 21l11llO1`l/lll;
SCl`\”lCG élllti L1 lllCLlllS ily \lViliCil i Cllll 1`Cltl1`ll tilt? SlgllC(i \\'11l\'C1` \\’llilO1ll COSI IO 1llC.
i i1;tQl`CC to SLIVC [ilC cost. of SCl`\’lCC Oii?21 Sl.lllllllO1lS Zlllti {lll Lliltiilletllili COD}! Oli lilti ajtlllllllilllll
in this lawsuit by not requiring that l be served withiudieial process in the mannerprovided bv
Rule 4. l will retain all defenses or objections to the lawsuit or to the _iurisdiction or venue ol the
(`Ollll, CXCLJIN lt)l` Oi)_l€CllOllS il2lSC(i Oil El LiCiCC\i1llilC SllllllllOllS Ol` lll lilC SLJl`\’l(`C <>lililC St1llllllOllS.
i l1lltiC1`S{21ll(i tilllf Ll_lLl(igGlll€1ll lllily be tIlllCl`C(i ZlgLllllSt lilC llillly (lll \\’ilOSC ilCilL1i`iii 211ll
acting ifa response is not served and tiled within 60 days after; October l 1. 2005.
· I . ` ,
Date;/Q /S/_,//e?ygf;_y
af ¥»¤·;ee».;t;§;___c_7!;i iz M S gx; S; t ag;
Sig,nature ot`Defendant Printed or Typed Name
I) U'l"i’ TO AVOID UNNECESSARY (.T()S'l` OF SlCRVl(`I€ €)E~` Sl_1i\»livl(¥NS
Rule 4 ol` the Federal Rules ol`Civil Procedure requires certain parties to cooperate in saxiine
llllllCCCSStll'y COSK OfS€l`\/ICS ofthe SLllll1llOllS Llllti tilt? Ctllllpiélllll. .·‘\ (lCI'€lldilll[ l(lC2lIL‘(l lll UIC
United States, who, after being notified ofau action and asked to waive service of summons
on behalfof a plaintiff located in the US, fails to do so will he required to bear the cost or
such service unless good cause be shown for that dei`endant‘s failure to sign and return ine
waiver.
ll lltll eood CLILISC i`O1` 21 l'l1liL11`C to WQIIVC SC1`VlCC lililt 21 llillly ilCiiC\’CS lilill lilC Ctllllllitlllll
Ll1liDtl1ltiC£i. U1" lilill lilC Zttjlitlll il2lS ilCC1l il1`OL1gill lll llll l1ll]l1`0llCl` ]li21CC O1` lll Z1 C(lL11`l lillll iLlCi(S
_l111`iS(iiCliO1l t)\i'C1` IilG SLIDICCI 1llL1lt€1` Ol`l.ilC &1CllO1l (ll` O\’Cl` (iCit)ll(iL11ll`S llC1`SOll (ll' |ll`0]lt)l`l}’. /\
tiUit'ill(iLllll \\’ilO W2ll\’CS SCl`\'iCC Oi`SLlllllllOllS l`Cl21lllS {iii tiCiCllSUS Llllti (>illt)Cll(lIlS. CXCUIN 1111}/
l`Cii1llllg to lilC SL11lllllOllS Ol` lilC SC1`VlCC Ol'iSL1lll1llOllS, 211lLi lllily i£1lCl` Oil_lCCl to lilC_ll1l`l§§tllCllOll Oli lilU
(`ourt or to the place to where the action has been brought.
A defendant who waives service must within the time specilied on the "Rcturn o1` Waiver"
lorm served on plaintiff, if unrepresented or on plaintiffs attorney, a response to the (`omplaint
and must also lile a signed copy ofthe response with the Court. ll`thc answer or a motion is not
served within this time, a default judgement may be taken against that delendant. liv waiving i
StJl`VlCC, Zl (iCi"Cll(iZtlll is allowed lllOl`€ lllllC to 21llSWG1” lililll ll`lilC St1lll1llO1lS ililti ilCtJ1l iltfllltlliy
SCl`\’C(i \\/ilC1l lilC request `f`O1` VVZ1l\’€l` OiiiSCl`ViCC \\’1lS l`CCCl\/C(i.