`
`3:21-cv-02495-JCS
`
`4/8/2021
`
`A. Kokich
`
`A T E S DISTRIC
`
`T
`
`S T
`
`Susan Y. Soong
`
`C
`
`O
`
`U R T
`
`RNIA
`
`A LIFO
`
`C
`
`E D
`
`UNIT
`
`N O R T
`
`H
`
`E R N
`
`DISTRICT O F
`
`
`
`Case 3:21-cv-02495-EMC Document 7 Filed 04/08/21 Page 2 of 6
`Case 3:21-cv-02495-EMC Document 7 Filed 04/08/21 Page 2 of 6
`
`A0 440 (Rev. 06/12) Summons in a Civil Action (Page 2)
`
`Civil Action No.
`
`(This section should not be filed with the court unless required by Fed. R. Civ. P. 4 (D)
`
`PROOF OF SERVICE
`
`This summons for (name of individual and title, ifany)
`
`
`was received by me on (date)
`
`
`
`III I personally served the summons on the individual at @lace)
` on (date) ; or
`
`
`
`
`
`III 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
`
`III I served the summons on (name ofindividual)
`
`
`
`, who is
`
`
`designated by law to accept service of process on behalf of (name oforganization)
`
`
`on (date)
`
`; or
`
`III I returned the summons unexecuted because
`
`
`
`; or
`
`D Other (spectfii):
`
`My fees are $
`
`for travel and $
`
`for services, for a total of $
`
`o_oo
`
`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:
`
`
`
`Case 3:21-cv-02495-EMC Document 7 Filed 04/08/21 Page 3 of 6
`
`3:21-cv-02495-JCS
`
`4/8/2021
`
`A. Kokich
`
`A T E S DISTRIC
`
`T
`
`S T
`
`Susan Y. Soong
`
`C
`
`O
`
`U R T
`
`RNIA
`
`A LIFO
`
`C
`
`E D
`
`UNIT
`
`N O R T
`
`H
`
`E R N
`
`DISTRICT O F
`
`
`
`Case 3:21-cv-02495-EMC Document 7 Filed 04/08/21 Page 4 of 6
`Case 3:21-cv-02495-EMC Document 7 Filed 04/08/21 Page 4 of 6
`
`A0 440 (Rev. 06/12) Summons in a Civil Action (Page 2)
`
`Civil Action No.
`
`(This section should not be filed with the court unless required by Fed. R. Civ. P. 4 (D)
`
`PROOF OF SERVICE
`
`This summons for (name of individual and title, ifany)
`
`
`was received by me on (date)
`
`
`
`III I personally served the summons on the individual at @lace)
` on (date) ; or
`
`
`
`
`
`III 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
`
`III I served the summons on (name ofindividual)
`
`
`
`, who is
`
`
`designated by law to accept service of process on behalf of (name oforganization)
`
`
`on (date)
`
`; or
`
`III I returned the summons unexecuted because
`
`
`
`; or
`
`D Other (spectfii):
`
`My fees are $
`
`for travel and $
`
`for services, for a total of $
`
`o_oo
`
`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:
`
`
`
`Case 3:21-cv-02495-EMC Document 7 Filed 04/08/21 Page 5 of 6
`
`3:21-cv-02495-JCS
`
`4/8/2021
`
`A. Kokich
`
`A T E S DISTRIC
`
`T
`
`S T
`
`Susan Y. Soong
`
`C
`
`O
`
`U R T
`
`RNIA
`
`A LIFO
`
`C
`
`E D
`
`UNIT
`
`N O R T
`
`H
`
`E R N
`
`DISTRICT O F
`
`
`
`Case 3:21-cv-02495-EMC Document 7 Filed 04/08/21 Page 6 of 6
`Case 3:21-cv-02495-EMC Document 7 Filed 04/08/21 Page 6 of 6
`
`A0 440 (Rev. 06/12) Summons in a Civil Action (Page 2)
`
`Civil Action No.
`
`(This section should not be filed with the court unless required by Fed. R. Civ. P. 4 (D)
`
`PROOF OF SERVICE
`
`This summons for (name of individual and title, ifany)
`
`
`was received by me on (date)
`
`
`
`III I personally served the summons on the individual at @lace)
` on (date) ; or
`
`
`
`
`
`III 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
`
`III I served the summons on (name ofindividual)
`
`
`
`, who is
`
`
`designated by law to accept service of process on behalf of (name oforganization)
`
`
`on (date)
`
`; or
`
`III I returned the summons unexecuted because
`
`
`
`; or
`
`D Other (spectfii):
`
`My fees are $
`
`for travel and $
`
`for services, for a total of $
`
`o_oo
`
`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:
`
`