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SUMMONS IN A CIVIL ACTION United States District Court for the District of Colorado
Civil Action Number:

PLAINTIFF(S), v.

SUMMONS

DEFENDANT(S). To the above named Defendant(s): You are hereby summoned and required to serve upon

plaintiff's attorney, whose address is:

AND FILE WITH THE CLERK OF THE COURT
an answer to the complaint which is herewith served upon you, within _____ days of service of this summons upon you, exclusive of the day of service. If you fail to do so, judgment by default will be taken against you for the relief demanded in the complaint.

Gregory C. Langham, Clerk By: Deputy Clerk (Seal of the Court) Date: Clerk, U.S. District Court, Room A-105 Alfred A. Arraj U.S. Courthouse, 901 19th Street, Denver, Colorado 80294-3589 NOTE: This summons is issued pursuant to Rule 4 of the Federal Rules of Civil Procedure.

RETURN OF SERVICE
NAME OF SERVER: Check one box to indicate appropriate method of service. TITLE:

Served personally upon the defendant. Place where left:

Left copies thereof at the defendant's dwelling house or usual place of abode with a person of suitable age and discretion then residing therein. Name of person with whom the summons and complaint where left:

Returned unexecuted::

Other (specify):

STATEMENT OF SERVICE OF FEES TRAVEL SERVICES TOTAL

DECLARATION OF SERVER

I declare under penalty of perjury under the laws of the United States of America that the foregoing information contained in the Return of Service and Statement of Service is true and correct. Executed on: Date Signature of Server

Address of Server