`
`AO 440 (Rev. 06/12) Summons in a Civil Action
`
`UNITED STATES DISTRICT COURT
`
`for the
`District of Massachusetts
`__________ District of __________
`
`Civil Action No.
`
`(cid:239)(cid:230)(cid:239)(cid:231)(cid:243)‰“(cid:243)(cid:239)(cid:239)(cid:238)Ø(cid:238)
`
`))))))))))))
`
`¸†•·–‰ (cid:238)(cid:240)(cid:239)Ø (cid:212)(cid:212)(cid:221)
`
`Plaintiff(s)
`v.
`
`—¿§‰‚»¤(cid:244) (cid:215)†‰(cid:242)
`
`Defendant(s)
`
`SUMMONS IN A CIVIL ACTION
`
`To: (Defendant’s name and address)
`
`—¿§‰‚»¤(cid:244) (cid:215)†‰(cid:242)
`‰æ– (cid:221)(cid:204) (cid:221)–fi(cid:176)–fi¿‹•–† ˝§›‹»‡
`(cid:239)(cid:231)(cid:231)(cid:231) (cid:222)fi§¿† ˝‹fi»»‹(cid:244) ˝«•‹» (cid:231)(cid:240)(cid:240)
`(cid:220)¿··¿›(cid:244) (cid:204)»¤¿› غ(cid:238)(cid:240)(cid:239)(cid:243)(cid:237)(cid:239)(cid:236)(cid:240)
`
`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:214)(cid:242) (cid:216)¿§»›
`—fi•†‰» (cid:212)–(cid:190)»· (cid:204)§» (cid:212)(cid:212)—
`(cid:209)†» (cid:215)†‹»fi†¿‹•–†¿· —·¿‰»(cid:244) ˝«•‹» (cid:237)Ø(cid:240)(cid:240)
`(cid:222)–›‹–†(cid:244) (cid:211)(cid:223) (cid:240)(cid:238)(cid:239)(cid:239)(cid:240)
`
`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
`
`Signature of Clerk or Deputy Clerk
`
`
`
`Case 1:19-cv-11272-RGS Document 1-5 Filed 06/07/19 Page 2 of 2
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`AO 440 (Rev. 06/12) Summons in a Civil Action (Page 2)
`Civil Action No.
`
`(cid:239)(cid:230)(cid:239)(cid:231)(cid:243)‰“(cid:243)(cid:239)(cid:239)(cid:238)Ø(cid:238)
`
`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:240)(cid:242)(cid:240)(cid:240)
`
`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
`
`