`
`AO 440 (Rev. 06/12) Summons in a Civil Action
`
`UNITED STATES DISTRICT COURT
`
`for the
`__________ District of __________
`
`Civil Action No.
`
`))))))))))))
`
`Plaintiff(s)
`v.
`
`Defendant(s)
`
`To: (Defendant’s name and address)
`
`SUMMONS IN A CIVIL ACTION
`
`A lawsuit has been filed against you.
`
`Within 21 days after service of this summons on you (not counting the day you received it) — or 60 days if you
`are the United States or a United States agency, or an officer or employee of the United States described in Fed. R. Civ.
`P. 12 (a)(2) or (3) — you must serve on the plaintiff an answer to the attached complaint or a motion under Rule 12 of
`the Federal Rules of Civil Procedure. The answer or motion must be served on the plaintiff or plaintiff’s attorney,
`whose name and address are:
`
`If you fail to respond, judgment by default will be entered against you for the relief demanded in the complaint.
`You also must file your answer or motion with the court.
`
`Date:
`
`CLERK OF COURT
`
` /s/ Randall Lohan
`Signature of Clerk or Deputy Clerk
`
`
`
`Case 1:25-cv-00140-JLH Document 5 Filed 02/07/25 Page 2 of 2 PageID #: 1332
`Case, 1:25-cv-00140-JLH
`Document 5
`Filed 02/07/25 ' Page 2 of 2 PageID #: 1332
`
`A0 440 (Rev. 06/12) Summons in a Civil Action (Page 2)
`
`Civil Action No. 25-140
`
`(This section should not befiled with the court unless required by Fed. R. Civ. P. 4 (1))
`
`PROOF OF SERVICE
`
`This summons for (name ofindividualandtitle, ifany) W k C) 0‘2 f In (»
`was received by me on (date)
`Q ~ 7 t 2 E
`.
`
`D I personally served the summons on the individual at (place)
`
`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
`
`kg H a m”
`Z a *3 6\
`i
`D
`Mservedthe summons on (nameafindividual)
`designated by law to accept service of process orf behalf of (name oforganizatian)
`5
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`01’1(date)
`
`'T he]
`
`; or
`
`, who is
`(0 P Q 0- r6193“ 0 h
`
`III I returned the summons unexecuted because
`
`; or
`
`D Other (specify):
`
`My fees are $ ~
`
`for travel and $
`
`for services, for a total of $
`
`0.00
`
`I declare under penalty of perjury that this information is true.
`
`
`
`Date: Q 1'1 5
`
` 1.mn Plat—‘2. L€,ét’ _C_0urf.€F
`
`
`Printed game and ti e
`
`
`
`
`Additional information regarding attempted service, etc:
`
`
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