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

,_ Case 1 :07-cv-00728-JJF Document 5 Filed 1 1/28/2007 Page 1 of 2
UNITED STATES DISTRICT Couar
pf Eng District of
Matthew Wiley, ‘ "
ffafnffff snMMoNs IN A crvn. CASE
V.
Star Chrysler/Jeep, LLC,
New Castle Insurance, LTD., M
and Blue Cross Blue Shield CASEPHHABERZ l O 7 ” 7 2 8‘"
Insurance,-
Defendants.
TO: (Name and address of Defendant)
Blue Cross Blue Shield Insurance by delivering copies to defedantls
agent located at 201 West 14th Street, Wilmington, DE 19801
YOU ARE HEREBY SUMMONED and required to serve on PLAINTIFFS ATTORNEY (name Ana auaresn
Law Offices of Joseph J. Rhoades
Joseph J. Rhoades, Esquire
1225 N. King Street
P.0. Box 874
Wilmington, DE 19899-0874
an answer to the complaint which is served on you with this summons, within 2 0 days after service
of this summons on you, exclusive of the day of service. If you fail to do so, judgment by default will he taken against you
for the relief demanded in the complaint. Any answer that you serve on the parties to this action must be filed with the
Clerk of this Court within a reasonable period of time after service.
term T. DAtl.Eo llll l l lll
N NOV it 4 ZEN
ctanx (C;/-_——*¢/€Ej————-_' DATE
KA.! V
(By) DEPUTY ctsax
l

l

Case 1 :07-cv-00728-JJF Document 5 Filed 1 1/28/2007 Page 2 of 2
• AO 440 (Rev. 8/Ol) Summons in a Civil Action . W
RETURN OF SERVICE
Service of the Summons and complaint was made by me(l) i) /07
NAME or smzvnn rrpmr) TITLE
BARRY EVELAND SPECIAL PROCESS SERVER
Check one box below to indicate a ro riate method o service
B Served personally upon the defendant. Place where served: SERVED: BLUE CRUSS BLUE SHIELD INSURANCE
AT 800 DELAWARE AVE. WHIMINGTON, DE. ACCEPTED BY FRANCIS MICZKOWSKI, ESQ.
E] 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 lett:
E] Returned unexecuted:
[I Other (specify):
STATEMENT OF SERVICE FEES
rimvet senvrcns worm.
DECLARATION OF SERVER
I 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 @2%-4?—Eees is true and correct.
Executed on 11/16/07
Date Signature of Server
BRANDYWINE PROCESS SERVERS, LTD.
P.O. BOX 1360 6
WILMINGTON, DE 19899-1360 I
302- 475-2600


l
l
l
(1) As to who may serve a summons see Rule 4 ofthe Federal Rules of Civil Procedure, l
l
l

Case 1:07-cv-00728-JJF

Document 5

Filed 11/28/2007

Page 1 of 2

Case 1:07-cv-00728-JJF

Document 5

Filed 11/28/2007

Page 2 of 2