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`Case 2:22-cv-00440-JRG Document9 Filed 11/21/22 Page 1 of 2 PagelD #: 50
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`11/21/22
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`Case 2:22-cv-00440-JRG Document 9 Filed 11/21/22 Page 2 of 2 PageID #: 51
`Case 2:22-cv-00440-JRG Document9 Filed 11/21/22 Page 2 of 2 PagelD#: 51
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`AO 440 (Rev. 06/12) Summonsin a Civil Action (Page 2)
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`Civil Action No. 2:22-cv-00440-JRG
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`(This section should notbefiled with the court unless required by Fed. R. Civ. P. 4 (1)
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`PROOF OF SERVICE
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`This summonsfor (nameofindividual andtitle, ifany)
`wasreceived by me on (date)
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`1 I personally served the summons on the individual at (place)
` on (date) ; Or
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`C1 I left the summonsat the individual’s residence or usual place of abode with (name)
`, a person of suitable age and discretion whoresides there,
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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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`CI served the summons on (nameofindividual)
`designated by law to accept service of process on behalf of (name oforganization)
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`on (date)
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`> Or
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`O} I returned the summons unexecuted because
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`Ol Other (specify):
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`Myfees are $
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`for travel and $
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`for services, for a total of $
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`0.00
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`I declare under penalty of perjury that this information istrue.
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`Date:
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`Server’s signature
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`Printed name andtitle
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`Server’s address
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`Additional information regarding attempted service,etc:
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