`
`A T E S DISTRIC
`
`T
`
`S T
`
`(cid:48)(cid:68)(cid:85)(cid:78)(cid:3)(cid:37)(cid:17)(cid:37)(cid:88)(cid:86)(cid:69)(cid:92)
`
`C
`
`O
`
`U R T
`
`RNIA
`
`A LIFO
`
`C
`
`E D
`
`UNIT
`
`N O R T
`
`H
`
`E R N
`
`DISTRICT O F
`
`5/26/2022
`
`
`
`Case 5:21-cv-04653-BLF Document 141 Filed 05/26/22 Page 2 of 6
`Case 5:21-cv-04653-BLF Document 141 Filed 05/26/22 Page 2 of 6
`
`AO 440 (Rev. 06/12) Summonsin a Civil Action (Page 2)
`
`Civil Action No. 5:21-cv-04653-BLF
`
`(This section should not befiled with the court unless required by Fed. R. Civ. P. 4 (i))
`
`PROOF OF SERVICE
`
`This summonsfor (nameofindividual andtitle, ifany)
`was received by me on(date)
`
`OI personally served the summons onthe individual at (place)
` on (date) 5 or
`
`
`
`1 IT left the summonsat 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
`
`, who is
`1 I served the summons on (nameofindividual)
`designated by law to accept service of process on behalf of (name oforganization)
`
`
`on (date)
`
`> or
`
`I returned the summons unexecuted because
`
`
`
`; or
`
`1 Other(specifi):
`
`Myfees are $
`
`for travel and $
`
`for services, for a total of $
`
`0.00
`
`I declare under penalty of perjury that this information is true.
`
`Date:
`
`
`
`Server 's signature
`
`
`
`Printed name andtitle
`
`
`
`Server's address
`
`Additional information regarding attempted service,etc:
`
`
`
`Case 5:21-cv-04653-BLF Document 141 Filed 05/26/22 Page 3 of 6
`
`A T E S DISTRIC
`
`T
`
`S T
`
`(cid:48)(cid:68)(cid:85)(cid:78)(cid:3)(cid:37)(cid:17)(cid:37)(cid:88)(cid:86)(cid:69)(cid:92)
`
`C
`
`O
`
`U R T
`
`RNIA
`
`A LIFO
`
`C
`
`E D
`
`UNIT
`
`N O R T
`
`H
`
`E R N
`
`DISTRICT O F
`
`5/26/2022
`
`
`
`Case 5:21-cv-04653-BLF Document 141 Filed 05/26/22 Page 4 of 6
`Case 5:21-cv-04653-BLF Document 141 Filed 05/26/22 Page 4 of 6
`
`AO 440 (Rev. 06/12) Summonsin a Civil Action (Page 2)
`
`Civil Action No. 5:21-cv-04653-BLF
`
`(This section should not befiled with the court unless required by Fed. R. Civ. P. 4 (i))
`
`PROOF OF SERVICE
`
`This summonsfor (nameofindividual andtitle, ifany)
`was received by me on(date)
`
`OI personally served the summons onthe individual at (place)
` on (date) 5 or
`
`
`
`1 IT left the summonsat 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
`
`, who is
`1 I served the summons on (nameofindividual)
`designated by law to accept service of process on behalf of (name oforganization)
`
`
`on (date)
`
`> or
`
`I returned the summons unexecuted because
`
`
`
`; or
`
`1 Other(specifi):
`
`Myfees are $
`
`for travel and $
`
`for services, for a total of $
`
`0.00
`
`I declare under penalty of perjury that this information is true.
`
`Date:
`
`
`
`Server 's signature
`
`
`
`Printed name andtitle
`
`
`
`Server's address
`
`Additional information regarding attempted service,etc:
`
`
`
`Case 5:21-cv-04653-BLF Document 141 Filed 05/26/22 Page 5 of 6
`
`A T E S DISTRIC
`
`T
`
`S T
`
`(cid:48)(cid:68)(cid:85)(cid:78)(cid:3)(cid:37)(cid:17)(cid:37)(cid:88)(cid:86)(cid:69)(cid:92)
`
`C
`
`O
`
`U R T
`
`RNIA
`
`A LIFO
`
`C
`
`E D
`
`UNIT
`
`N O R T
`
`H
`
`E R N
`
`DISTRICT O F
`
`5/26/2022
`
`
`
`Case 5:21-cv-04653-BLF Document 141 Filed 05/26/22 Page 6 of 6
`Case 5:21-cv-04653-BLF Document 141 Filed 05/26/22 Page 6 of 6
`
`AO 440 (Rev. 06/12) Summonsin a Civil Action (Page 2)
`
`Civil Action No. 5:21-cv-04653-BLF
`
`(This section should not befiled with the court unless required by Fed. R. Civ. P. 4 (i))
`
`PROOF OF SERVICE
`
`This summonsfor (nameofindividual andtitle, ifany)
`was received by me on(date)
`
`OI personally served the summons onthe individual at (place)
` on (date) 5 or
`
`
`
`1 IT left the summonsat 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
`
`, who is
`1 I served the summons on (nameofindividual)
`designated by law to accept service of process on behalf of (name oforganization)
`
`
`on (date)
`
`> or
`
`I returned the summons unexecuted because
`
`
`
`; or
`
`1 Other(specifi):
`
`Myfees are $
`
`for travel and $
`
`for services, for a total of $
`
`0.00
`
`I declare under penalty of perjury that this information is true.
`
`Date:
`
`
`
`Server 's signature
`
`
`
`Printed name andtitle
`
`
`
`Server's address
`
`Additional information regarding attempted service,etc:
`
`