Case 1 :07-cv—00775—G|\/IS-LPS Document 7 Filed 12/07/2007 Page 1 of 1
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RETURN OF SERVICE
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Service of the Summons and complaint was made by mea) DATE | Q / §` / Q 7
NAME OF SERVER PRINT TITLE A J 1
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Check one box below to indicate appropriate method of service
Served personally upon the defendant. Place where served: E
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Left copies thereof at the defendants dwelling house or usual place of abode with a person of suitable age 1
and discretion then residing therein.
Name of person with whom the summons and complaint were left: W1 {Q `Ta t 1 O ,»~ Sy ( ) {
Returned unexecuted:
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Other (specify):
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STATEMENT OF SERVICE FEES 1
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TRAVEL SERVICES TOTAL 1
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. DECLARATION OF SERVER 1
I declare under penalty of perjury under the laws of the United States of America that the foregoing 1
information contained in the Return of Service and Statement of Service Fees is true and correct.
Executed on: J 5â€A)") L 1.... I k C{ U.·L;{" p 1 A pQ%%
DHYG Signature of Server p Va V S.{U€
S D1 Vw. b tf za V 0/
_ Address of Sewer [
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(1) As to ho may serve a summons see Rule 4 of the Federal Rules of Civil Procedure.
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Case 1:07-cv-00775-GMS-LPS
Document 7
Filed 12/07/2007
Page 1 of 1