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

Case 1 :04-cv-00921-SLP Document 64 Filed 01/13/2006 Page 1 of 2
.?lt$’12/QBBFS It 3El2i55'EiE»EiEEW U DEPUTY WARDEN PIERCE PAGE ggjgp
I - 1 me Ii, I ;nog_Z_I`tI a5s rn nos t·ttiaIs_t§tat__5 uzut·t.nssa2I s'.roI.s21a itc} a1Iso2ssaIsssrII- Pros-
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- i I , _: I- I I -II:I’t I- . .. OF WAIWQERIOF SERVICEIOF 1% - I I, I
. 3 1 I I, n` n . 1-he tihqut-ist Llwtl Gain waive service or inthe matter of i*iiI-` _t Ii i I
_ V- I I `I - I cnt. No.jlj—Q2Il in the United States District of Delaware; I have also received a oopyot'thc j I I . : I I
I _ I complaint inthe action, two copieslof this form, a copy of Order ofthe Court authorizing . 1`.-5 I
1 service itnda means by which I can return the signed waiver without cost to nie.-_ _ -I I _ I_ I 1 _
_ I _ I .t . I E I II agree to save the oostjof service of a stuntnorts and an additional copy of the oompli1intII;1,I 1 _ I -.
- . I . I I . I in this lawsuit byrietrequirin . t I _ Rule 4. III willretain all defenses or obj cctions to lawsuit or to the jurisdiction or venue ol` the 1 1 -1 Q I. I
- - I 1 Court, except tht objections based on a defect in thesurnrnons or in the service ofthe summons. I I A
I I 1 I 1 ` n n Itinderstanci that judgement cnterediagainstthe party on whosebehnlfl am ` ;-at I n
I I ` acting it`a response is not served and filed within 60 days after: blgvem gt; 1jZ, 200;, 1 1 I I .
n Datedttttlogg I -I II _ n - . II T I _ I - . I
I l': n-. éggt-it ' I _ _L_Q_I.‘>.a-t·.s/·£. I·l>urr,'.t l- _i. n. 1I: n I
1 I Signature of Defendant _ Printed or Typed Name . - ` 1. . .' I
n I - i _ _ DUTY TO AVOID UNNECESSARY COST OF SERVICE OF SUMMONS I n n n -1
I n i P i jtRulo 4 of federal Rules of:Civil.Proccdurc requires parties to choperate 'inIsavingI I I I I
I-_ . uruteccssnry cost of service ofthe summons and the complaint. A defendant located in the _.-1‘ _I I
-_ __ _ I United States, `who, after being notified of an action andasked to weivo service of summons 2- I - _
" 1 - on behalf of a plaintiff located in the US, falls to do so will be required to bear the cost of Q It 1 1 .
I I such service unless good cause be shown for that dBfE11dRI1t'§ failure to sign and return the I 1 I 1
I _waivIer.I I I _ I - _ _ I _ I I It I 1 _ .
, It is not good cause for a failure to waive service that a party believes that the complaint is I _- I
_ . I unfounded, or that the action has been brought in an improper place or a court that lacks .-_`
- jurisdiction over thc subject matter of the action or ovtn·It;1,et`endnnt’s person oripropcrty. A _, 1 .
11 I defendant who waives service of summons retains all defenses and objections, except any .
relating to the summons or the service of summons, and may. later object to tbcjurisdiction ofthe I
- Court or to-the place to where the action hes been brought. · I- I . .
IA defendant who waives service must within the time specified on the "R.etut·n of Waiver" I I -
I - - - ihrnt served on plaintiff] if unrepresentcd or on plaintiffs attorney, n response to the Complaint I
1 I - I and must also tile a, signed copy ol` the response with the Court. If the answer or a motion is not I I
_ I 1 served within this time, a default judgement may be taken against that detbruiant. By waiving 1
]I 1 service, at defendant is allowed more time to answer than if the summons had been actually
- III served when the request for waiver of service was received. 1 I 1 _ -
. · 1 ' _ f'*·.`!
I ° I » I I . I I I U in I II1.
- _ - - , I ` . . ire.) ` .
_ 1 ._. 1 :1 I . ` U1 IIEI II
`1. i I I .' ‘: - lr on Threat i:icar:¢ mq um n

g Case 1:04-cv—O0921-SLR Document 64 Filed O1/13/2006 Page 2 of 2
rl S Department of Justice PROCESS RECEH. I M In RE I URN
‘ _ ‘ ` _ See lnstmctrons for "Servrce of Hocess by the US. Marshal"
Untted States Marshals Servtce on me mma of this am.

PLAINTIFF I _ , L _ COURT CASE NUMBER
_ A/Page //45 ` OLi"Gi·9i
DEFENDANT . . K . 7 — TYPE OI: PROCESS _
EZ Z»7»6.» /4/ (/réré/J C0/W /¢i/AM
SERVE . NAMEVOF INDIVIDUAL, CO CORPORATION, ETC., TO SERVE OR DESCRIPTION OF PROPERTYTO IZE OR CONDEMN
» E-{2 2%/767%/ (//€z€/5 I -
ADDRESS (Street or RFD, Apartment No., City; State and ZIP Code) 7
· AT Dyfawaea &»ea».=·c¤7/aaa/!e1¤»T;a·a ,//W }?:»_& a ( Sm em, D4://V?77
£3HD.Y*PEQ?·2ES£R"EE Q)£Y.T2 BEPEEETEEE EWE A@;°*.'?lDL*l§§.l?lil1i’!;-| Numb., nf process tt-, be
__ " " ;· ‘ I d'thtl-r`F -285 · Z
7 I AHS ,Z.j_}kli\rJOt}Ci gg/Ag Scrve wt is nm 7 7
. C ` ‘ _ · - I _ ’
/ . 7 K 4 7* ,4/ J Alygf I Number of parties to be .
Dé_’4kJ’A£€ Ozzécgcw F I served in7this case 2 V
I / °-YY? {NA;-DF I A
/ A 7 - O ‘ OA Q / _ I Check for service — _
__________ _______ __ ____ on U.S.A. V . _ r ,_7;L h .
SPECIAL INSTRUCTIONS OR O'I'HER INFORMATION THAT WILL ASSIST IN EXPEDITING SERVICE (Include Business and Alte c Aifltidifsses, All
Flgllephone Numbers, and Estimated Times Available For Service): ` ” V ·='P~·· - - '·rr·
d r ’ _ ' 7 7 - NH. ,.: -g Fbld
_ W7 , 7 ‘ - 7 7 V . , ` Q,.J— ‘iaI_Q·_·-77_ W
. ‘ 7 77 {/ti) @45 6- » l · l i ‘ ` Z .
I E E c I - · l is lie
g A I - “ ec 2
I UI L ,
Signature of Attomey or othtér Ori in or requesting service on behalf of: H PLAINTIFF TELEPHONE NUMBER I DATE - 7
ji ", ' lj DEFENDANT /I/{A7 /—· 'Q?-6 S
SPACE BELOW FOR USE OF U.S. MARSHAL ONLY — DO NOT WRITE BELOW THIS LINE
l acknowledge receipt for the total Total Process District District Signature o Authorized USMS Deputy or Cle k Date
number of process indicated. of Origin to Serve 7//
(Sign only Hrst USM 285 if more I { ...- ,,,.0
than one USM 285 is submitted) No. No. L L
I hereby certify and return that I [I have personally served,x have legal evidence of service, I] have executed as showin in “Remarks", the process described
` on the individual, company, corporation, ete., at the address shown above or on the individual, company. corporation, etc., shown`at the address inserted below.
I] 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-
iii cretion then residing in the defer1dant’s
ttsua] plaee of abode.
Address (complete only if different than shown above) Date of Service Time am
[ 1* lou Pm
Signature of U.S. Marshal or Deputy 7
sd r
. . HH
Service Fee j Total Mileage Charges Forwarding Fee Total Charges Advance Deposits Amount owed to U.S.¤Marshal or Amount of Refund
( including errdea vors)
REMARKS: U

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