Case: 3:25-cv-00698 Document #: 1-12 Filed: 08/20/25 Page 2 of 2
AO 440 (Rev. 06/12) Summons in a Civil Action (Page 2) Civil Action No. 25-cv-698
PROOF OF SERVICE (This section should not be filed with the court unless required by Fed. R. Civ. P. 4 (l))
This summons for (name of individual and title, if any)
was received by me on (date)
.
’ I personally served the summons on the individual at (place)
on (date)
; or
’ I left the summons at the individual’s residence or usual place of abode with (name)
, a person of suitable age and discretion who resides there,
on (date)
, and mailed a copy to the individual’s last known address; or
, who is
’ I served the summons on (name of individual)
designated by law to accept service of process on behalf of (name of organization) on (date)
; or
’ I returned the summons unexecuted because
; or
’ Other (specify):
.
My fees are $
for travel and $
for services, for a total of $
.
0
I declare under penalty of perjury that this information is true.
Date:
Server’s signature
Printed name and title
Server’s address
Additional information regarding attempted service, etc:
Save As...
Reset
Made with FlippingBook - Online catalogs