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`JLS (ADSx)
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`July 15, 2019
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`Jenny
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`Kiry Gray
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` Jennylam
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`/s/
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`Case 8:19-cv-01150-JLS-ADS Document 13 Filed 07/15/19 Page 2 of 2 Page ID #:80
`Case 8:19-cv-01150-JLS-ADS Document 13 Filed 07/15/19 Page 2 of 2 Page ID #:80
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`A0 440 (Rev. 06! 12) Summons in a Civil Action (Page 2)
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`Civil Action No. 8:19-cv-01150
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`(This section shout'd not befiled with the court unless required by Fed. R. Civ. P. 4 (1))
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`PROOF OF SERVICE
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`This summons for (name ofmdividual and title, army)
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`was received by me on (date)
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`[II
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`I personally served the summons on the individual at grime)
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`[II
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`I left the summons at the individual’s residence or usual place of abode with (name)
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`, a person of suitable age and discretion who resides there=
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`on (date)
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`; 01'
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`on (date)
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`, and mailed a copy to the individual’s last known address; or
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`III I served the summons on {waste qf‘mdr'vidual)
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`, who is
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`designated by law to accept service of process on behalf of (name oforganization)
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`01’} (date)
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`; or
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`D I returned the summons unexeCuted because
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`; or
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`D Other fispeetfi):
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`My fees are $
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`for travel and $
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`for services, for a total of 3;
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`(mg
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`I declare under penalty of perjury that this information is true.
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`Date:
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`Server ’5 signature
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`Primed name and title
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`Additional information regarding attempted service, etc:
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`Server ’3 address
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