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`Shaquela
`Howard
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`Digitally signed by Shaquela
`Howard
`Date: 2022.11.23 10:59:28 -05'00'
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`Case 1:22-cv-01331-MSN-JFA Document 5 Filed 11/23/22 Page 2 of 2 PageID# 303
`Case 1:22-cv-01331-MSN-JFA Document5 Filed 11/23/22 Page 2 of 2 PagelD# 303
`
`AO 440 (Rev. 06/12) Summonsin a Civil Action (Page 2)
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`Civil Action No. 1:22-cv-1331
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`PROOF OF SERVICE
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`(This section should not befiled with the court unless required by Fed. R. Civ. P. 4 ()
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`This summonsfor (name ofindividual andtitle, ifany)
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`wasreceived by meon(date)
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`1 I personally served the summonsonthe individualat (place)
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` on (date) ; or
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`C1 IT left the summonsat the individual’s residence or usual place of abode with (name)
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`, aperson of suitable age and discretion whoresidesthere,
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`on (date)
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`, and mailed a copyto the individual’s last known address; or
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`, who is
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`designated by law to accept service of process on behalf of (nameoforganization)
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`C I returned the summons unexecuted because
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`1 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 informationis true.
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`; or
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`Date:
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`Server's signature
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`Printed nameandtitle
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`Server's address
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`Additional information regarding attempted service,etc:
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