`
`AO 440 (Rev. 06/12) Summons in a Civil Action
`
`UNITED STATES DISTRICT COURT
`
`for the
`Eastern District of Virginia
`__________ District of __________
`
`Civil Action No.
`
`(cid:22)(cid:30)(cid:22)(cid:22)(cid:71)(cid:90)(cid:20)(cid:20)(cid:20)(cid:20)(cid:22)
`
`))))))))))))
`
`(cid:39)(cid:41)(cid:50)(cid:56)(cid:54)(cid:45)(cid:52)(cid:41)(cid:56)(cid:37)(cid:48) (cid:50)(cid:41)(cid:56)(cid:59)(cid:51)(cid:54)(cid:47)(cid:55)(cid:16) (cid:45)(cid:50)(cid:39)(cid:18)
`
`Plaintiff(s)
`v.
`
`(cid:47)(cid:41)(cid:61)(cid:55)(cid:45)(cid:43)(cid:44)(cid:56) (cid:56)(cid:41)(cid:39)(cid:44)(cid:50)(cid:51)(cid:48)(cid:51)(cid:43)(cid:45)(cid:41)(cid:55)(cid:16) (cid:45)(cid:50)(cid:39)(cid:18)
`
`Defendant(s)
`
`To: (Defendant’s name and address)
`
`SUMMONS IN A CIVIL ACTION
`
`(cid:47)(cid:41)(cid:61)(cid:55)(cid:45)(cid:43)(cid:44)(cid:56) (cid:56)(cid:41)(cid:39)(cid:44)(cid:50)(cid:51)(cid:48)(cid:51)(cid:43)(cid:45)(cid:41)(cid:55)(cid:16) (cid:45)(cid:50)(cid:39)(cid:18)
`(cid:39)(cid:56) (cid:39)(cid:51)(cid:54)(cid:52)(cid:51)(cid:54)(cid:37)(cid:56)(cid:45)(cid:51)(cid:50) (cid:55)(cid:61)(cid:55)(cid:56)(cid:41)(cid:49)(cid:16) (cid:54)(cid:41)(cid:43)(cid:45)(cid:55)(cid:56)(cid:41)(cid:54)(cid:41)(cid:40) (cid:37)(cid:43)(cid:41)(cid:50)(cid:56)
`(cid:24)(cid:27)(cid:20)(cid:21) (cid:39)(cid:51)(cid:60) (cid:54)(cid:51)(cid:37)(cid:40)(cid:16) (cid:55)(cid:57)(cid:45)(cid:56)(cid:41) (cid:22)(cid:28)(cid:25)
`(cid:43)(cid:48)(cid:41)(cid:50) (cid:37)(cid:48)(cid:48)(cid:41)(cid:50)(cid:16) (cid:58)(cid:37) (cid:22)(cid:23)(cid:20)(cid:26)(cid:20)(cid:17)(cid:26)(cid:28)(cid:20)(cid:28)
`
`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:
`(cid:55)(cid:88)(cid:73)(cid:84)(cid:76)(cid:73)(cid:82) (cid:41)(cid:18) (cid:50)(cid:83)(cid:83)(cid:82)(cid:69)(cid:16) (cid:41)(cid:87)(cid:85)(cid:18)
`(cid:47)(cid:69)(cid:89)(cid:74)(cid:81)(cid:69)(cid:82) (cid:10) (cid:39)(cid:69)(cid:82)(cid:83)(cid:80)(cid:73)(cid:87)(cid:16) (cid:52)(cid:18)(cid:39)(cid:18)
`(cid:21)(cid:25)(cid:20) (cid:59)(cid:18) (cid:49)(cid:69)(cid:77)(cid:82) (cid:55)(cid:88)(cid:86)(cid:73)(cid:73)(cid:88)(cid:16) (cid:55)(cid:89)(cid:77)(cid:88)(cid:73) (cid:22)(cid:21)(cid:20)(cid:20)
`(cid:50)(cid:83)(cid:86)(cid:74)(cid:83)(cid:80)(cid:79)(cid:16) (cid:58)(cid:37) (cid:22)(cid:23)(cid:25)(cid:21)(cid:20)
`(cid:56)(cid:30) (cid:12)(cid:27)(cid:25)(cid:27)(cid:13) (cid:26)(cid:22)(cid:24)(cid:17)(cid:23)(cid:22)(cid:23)(cid:29)(cid:31) (cid:42)(cid:30) (cid:12)(cid:28)(cid:28)(cid:28)(cid:13) (cid:23)(cid:26)(cid:20)(cid:17)(cid:29)(cid:20)(cid:29)(cid:22)
`(cid:87)(cid:73)(cid:82)(cid:83)(cid:83)(cid:82)(cid:69)(cid:36)(cid:79)(cid:69)(cid:89)(cid:74)(cid:71)(cid:69)(cid:82)(cid:18)(cid:71)(cid:83)(cid:81)
`
`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:
`
`(cid:20)(cid:18)(cid:24)(cid:18)(cid:21)(cid:19)(cid:21)(cid:21)
`
`CLERK OF COURT
`
`2022.01.05 13:55:10
`-05'00'
`Signature of Clerk or Deputy Clerk
`
`
`
`Case 2:22-cv-00002-AWA-DEM Document 13 Filed 01/05/22 Page 2 of 2 PageID# 1279
`
`AO 440 (Rev. 06/12) Summons in a Civil Action (Page 2)
`Civil Action No.
`
`(cid:22)(cid:30)(cid:22)(cid:22)(cid:71)(cid:90)(cid:20)(cid:20)(cid:20)(cid:20)(cid:22)
`
`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,
`, and mailed a copy to the individual’s last known address; or
`
`on (date)
`
`I served the summons on (name of individual)
` designated by law to accept service of process on behalf of (name of organization)
`on (date)
`
`I returned the summons unexecuted because
`
`Other (specify):
`
`; or
`
`, who is
`
`; or
`
`My fees are $
`
`for travel and $
`
`for services, for a total of $
`
`(cid:20)(cid:18)(cid:20)(cid:20)
`
`I declare under penalty of perjury that this information is true.
`
`.
`
`.
`
`Date:
`
`Additional information regarding attempted service, etc:
`
`Server’s signature
`
`Printed name and title
`
`Server’s address
`
`
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