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`’ STATEMENT OF SERVICE (DELIVERY)-
`’ SMALL CLAIMS
`Pb8:3440Rev. 419
`
`‘|
`
`SMRSOS
`
`
`STATE OF CONNECTICUT
`Keo
`www.jud.ct.gov ¥ By
`SUPERIOR COURT |
`to have the Small Claims Writ and Notice of Suit and related documents served on the defendant.
`
`
`Instructions
`If filed on paper, fill out one (1) form for each defendant. Attach all documents showing how the Small
`Claims Writ and Notice of Suit (form JD-CV-40) and related documents were servedon (deliveredto)
`the defendant, and check the box below that applies. Keep all receipts showing how much you paid
`
`If filed electronically, follow the instructions above and ensure that you select the appropriate name of
`the document you are filing.
`
`For service on (delivery fo) the defendant:
`(Write name ofdefendant‘abows)
`
`The Smail Claims Writ and Notice of Suit (form JD-CV-40) and related documents,if any, were served on (deliveredto) the
`defendant named above by:
`
`(Check the box that applies)
`1.)
`priority mail with delivery confirmation; delivery confirmation is attached. | paid $
`
`\ O. 5S
`
`for this, or
`
`2.) (| certified mail, return receipt requested, or with electronic delivery confirmation; signed return receipt, or electronic
`delivery confirmation, is attached. | paid $
`for this, or
`
`3.)
`
`[_] anationally recognized courier service providing delivery confirmation; tracking information showing delivery
`is attached. | paid $
`for this, or
`
`4.)
`
`(_] a properofficer in the mannerin which a writ of summonsis servedin a civil action; officer's return of service
`
`filed with the court.
`
`gifitiffs representative)
`
`_.
`
`”
`
`Printname
`
`6. signed
`
`clerk or an ADA contact personlisted at www.jud.ct.gov/ADA
`
`ADA NOTICE
`
`The Judicial Branch of the State of Connecticut complies with the
`Americans with Disabilities Act (ADA). If you need a reasonable
`accommodation in accordance with the ADA, contact a court
`
`
`
`versed - USPS Tracking® Results
`
`i,
`
`USPS Tracking
`
`.
`
`®
`
`7/8/19, 9:31 AM
`
`FAQs > (https://www.usps.com/faqs/uspstracking-faqs.htm)
`
`an
`
`.
`
`Track Another Package +
`
`Tracking Number: 70183090000058297386
`
`Remove X
`
`Expected Delivery on
`
`TUESDAY
`
`1 8 yune.
`
`PY
`
`2019 8:00pme@
`
`Y Delivered
`June 18, 2019 at 10:15 am
`Delivered, Left with. lndividual
`NORWALK, CT 06851
`
`Get Updates \v
`
`
`
`Text & Email Updates
`
`
`Tracking History
`
`June 18, 2019, 10:15 am
`Delivered, Left with Individual
`NORWALK, CT 06851
`Youritem was delivered to an individual at the address at 10:15 am on June 18,
`2019 in NORWALK, CT 06851.
`
`https://tools.usps.com/go/TrackConfirmAction?tLabels=70183090000058297386
`
`Page 1 of 4
`
`
`
`USPS.com® - USPS Tracking® Results
`oaoe
`
`7/8/19, 9:31 AM
`
`June 18, 2019, 8:23 am
`Out for Delivery
`NORWALK, CT 06851
`
`June 18, 2019, 8:13 am
`Sorting Complete
`NORWALK, CT 06851
`
`June 18, 2019, 6:15 am
`Arrived at Unit
`
`NORWALK, CT 06850
`
`June 18, 2019, 5:59 am
`Arrived at USPSFacility
`NORWALK, CT 06850
`
`June 18, 2019, 5:34 am
`Arrived at USPSFacility
`NORWALK, CT 06854
`
`June 18, 2019, 5:07 am
`Departed USPS Regional Facility
`STAMFORDCT DISTRIBUTION CENTER
`
`June 18, 2019, 2:57 am
`Arrived at USPS Regional Facility
`STAMFORD CT DISTRIBUTION CENTER
`
`June 17, 2019, 4:01 pm
`Departed PostOffice
`NEW CANAAN, CT 06840
`
`June 17, 2019, 2:09 pm
`USPSin possession of item
`
`yoeqpes
`
`https://tools.usps.com/go/TrackConfirmAction?tLabels=70183090000058297386
`
`Page 2 of 4
`
`
`
`«STATEMENT OF SERVICE (DELIVERY)—
`MA cAIMS
`'P.B.§24-10
`
`Instructions
`if filed on paper, fill out one (1) form for each defendant. Attach all documents showing how the Small
`Claims Writ and Notice of Suit (form JD-CV-40) and related documents were served on (deliveredto)
`the defendant, and check the box below that applies. Keep all receipts showing how much you paid
`
`SMRSOS
`
`
`STATE OF CONNECTICUT
`
`SUPERIOR COURT ([*
`www,jud.ctgov
`‘es
`to have the Small Claims Writ and Notice of Suit and related documents served on the defendant.
`
`
`
`
`If filed electronically, follow the instructions above and ensure that you select the appropriate name of
`the documentyouare filing.
`
`For service on (delivery fo) the defendant:
`
`EaPER,NEAT
`(Write name of defendant above)
`
`The Small Claims Writ and Notice of Suit (form JD-CV-40) and related documents,if any, were served on (delivered fo) the
`defendant named aboveby:
`
`(Check the box that applies)
`1.)
`priority mail with delivery confirmation; delivery confirmation is attached. | paid $ )0. s5
`
`for this, or
`
`2.) (| certified mail, return receipt requested, or with electronic delivery confirmation; signed return receipt, or electronic
`delivery confirmation, is attached. | paid $
`for this, or
`
`3.)
`
`[J] a nationally recognized courier service providing delivery confirmation; tracking information showing delivery
`is attached. | paid $
`for this, or
`
`4.)
`
`[(_]a properofficer in the mannerin which a writ of summonsis servedin a civil action; officer's return of service
`
`filed with the court.
`
`
`
`Bigned (Plaintiff op plaintiff's representative)_ “ERAEA GAAER.
`
`
`
` Date signed
`
`6-24-14
`
`
`clerk or an ADA contact personlisted at www.jud.ct.gov/ADA
`
`ADA NOTICE
`The Judicial Branch of the State of Connecticut complies with the
`Americans with Disabilities Act (ADA). If you need a reasonable
`accommodation in accordance with the ADA, contact a court
`
`
`
`
`USPS.com® - USPS Tracking® Results
`tayws
`i» *
`
`7/8/19, 9:26AM
`
`USPSTracking’
`
`FAQs > (https://www.usps.com/faqs/uspstracking-faqs.htm)
`
`Track Another Package +
`
`Tracking Number: 70183090000058297393
`
`Remove X
`
`Expected Delivery on
`
`TUESDAY
`
`1 8 D019® - 8.00pmo
`
`Y Delivered
`June18; 2019at-+0:15am
`Delivered, Left with Individual
`NORWALK, CT 06851
`
`Get Updates \v
`
`
`
`Text & Email Updates
`
`
`Tracking History
`
`June 18, 2019, 10:15 am
`Delivered, Left with Individual
`NORWALK, CT 06851
`Your item wasdelivered to an individual at the address at 10:15 am on June 18,
`2019 in NORWALK, CT 06851.
`
`https://tools.usps.com/go/TrackConfirmAction?tLabels=70183090000058297393
`
`Page 1 of 4
`
`
`
`USPS.com® - USPS Tracking® Results
`- ~
`
`7/8/19, 9:26 AM
`
`June 18, 2019, 8:23 am
`Out for Delivery
`NORWALK, CT 06851
`
`June 18, 2019, 8:13 am
`Sorting Complete
`NORWALK, CT 06851
`
`June 18, 2019, 6:15 am
`Arrived at Unit
`
`NORWALK, CT 06850
`
`June 18, 2019, 5:59 am
`Arrived at USPS Facility
`NORWALK,CT 06850
`
`June 18, 2019, 5:34 am
`Arrived at USPSFacility
`NORWALK, CT 06854
`
`June 18, 2019, 5:07 am
`Departed USPS Regional Facility
`STAMFORDCT DISTRIBUTION CENTER
`
`June 18, 2019, 2:57 am
`Arrived at USPS Regional Facility
`STAMFORDCT DISTRIBUTION CENTER
`
`June 17, 2019, 4:01 pm
`Departed Post Office
`NEW CANAAN, CT 06840
`
`June 17, 2019, 2:09 pm
`USPSin possession of item
`
`yoeqpss-
`
`https://tools.usps.com/go/TrackConfirmAction?tLabels=70183090000058297393
`
`Page 2 of 4
`
`
`
`USPS.com® - USPS Tracking® Results
`@
`“
`
`.
`
`NEW CANAAN, CT 06840
`
`7/8/19, 9:26 AM
`
`
`
`Product Information
`
`
`
`See Less NY
`
`Can’t find what you’re looking for?
`
`Go to our FAQs section to find answers to yourtracking questions.
`
`FAQs(https://www.usps.com/fags/uspstracking-faqs.htm)
`
`The easiest tracking number
`is the one you don't have to
`know.
`
`With Informed Delivery®, you never
`have to type in another tracking
`number. Sign upto:
`
`e See images* of incoming mail.
`
`e Automatically track the packages
`you're expecting.
`
`e Set up email and text alerts so
`you don't need to enter tracking
`numbers.
`
`https://tools.usps.com/go/TrackConfirmAction?tLabels=70183090000058297393
`
`Page 3 of 4
`
`
`
`
`
`USPS.com® - USPS Tracking® Results
`e* oft a ~
`
`7/8/19, 9:26 AM
`
`e Enter USPS Delivery
`Instructions” for your mail carrier.
`
`Sign Up
`
`(https://reg.usps.com/entrec
`
`“NOTE: Black and white (grayscale)
`images shenPHdsarserishanrnyRi=ht
`letter-sized envelopes and mailpieces
`that are processed through USPS
`automated equipment.
`
`
`
`https://tools.usps.com/go/TrackConfirmAction?tLabels=70183090000058297393
`!
`
`Page 4 of 4
`
`
`
`
`
`
`
`
`
`NEW “CANAAN
`18 LOCUST AVE
`NEW CANAAN, CT
`06840-4762
`0846560840
`
`
`2:ile> PH
`Product
`Sale
`“Final
`Description
`Qty
`Price
`
`Here
`
`Hes7 7/209
`
`uke3
`
`
`fete
`re SOF
`
`
` maggoog544e343
`
` Postmark
`
` SREeeeoo000OLDEgTOe
`
`
`ATFI
`—Fp?EFresetPy
`
`=OLDEan
`
`
`
`6 ine /e1/e0
`
`HRAEYSOe}
`
`OOH
`
`1
`
`!
`
`06857)
`
`PM 1-Day
`Flat Rate Env
`(Domestia)
`(NORWALK, CT O68513
`(Flat Rate)
`(Expected Delivery Day)
`(Tuesday 06/18/2019)
`Certified
`1
`(@BUSPS Certified Mail #)
`C7018.30900001058297393)
`PM 1-Day
`1
`Flat Rate Env
`(Domestic)
`(NORWALK, CT
`(Flat Rate)
`(Expected Delivery Day)
`(Tuesday 06/18/2019)
`Certified
`1
`(@SUSPS Certified Mail #)
`(7018309000005829 7386)
`
`$7.35
`
`$3.50
`
`$7.35
`
`$3.50
`
`$21.70
`
`$21.70
`
`Total
`
`Crecit Card Remi td
`(Card Name: AMEX)
`CACCOUNTE OOK OOOOOOKE O08
`{Approval #:830702)
`(Transaction #:762)
`(ATN: AGONOOON2501 0801
`Chip)
`CAL: AMERTCAN EXPRESS)
`(PIN: Not Required)
`
`Tneludes up to $50 insurance
`Text your tracking riumker
`to 28777
`(2QUSPS)
`to get the latest status.
`Standard Message and Data rates may
`apply. You may alsa visit: waw. usps. ccm
`
`© Tracking or call 1-800-222-1811.
`
`Ziv a hurry? Sel f-service kiosks of far
`quick ancl easy check-out. Any Retail
`Associate can show you how.
`
` 2 thts receipt as evidence of
`insurance. For
`information on filing
`aq insurance claim go to
`ittos ://wauw. usps .com/help/el alins. rtm
`
`Preview your Mai]
`Track your Packages
`Sign up for FREE @
`wow. informeddel i very. com
`
`All sales
`final on stamps and postage.
`Refunds for guararteed services only
`Thank you for your business.
`
`HELP US SERVE YGU BETTER
`
`TELL US ABOUT YOUR RECENT-
`POSTAL EXPERTENCE
`
`
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