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OAO83 (Rev. 12/85) Summons in a Criminal Case

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UNITED STATES DISTRICT COURT
WESTERN
DISTRICT OF

MICHIGAN

UNITED STATES OF AMERICA V.

SUMMO NS IN A CRIMINAL CASE
Case Number:

(Name and Address of Defendant)

YOU ARE HEREBY SUMMONED to appear before the United States District Court at the place, date and time set forth below.

Place

Room

Date and Time Before: To answer a(n) G Indictment

G

Information

G

Complaint

G

Violation Notice

G

Probation Violation Petition

Charging yo u with a violation of Title Brief description of offense:

United States Cod e, Section(s)

Signature of Issuing Officer

Date

Name and Title of Issuing Officer

AO83 (Rev. 12/85) Summons in a Criminal Case

RETURN OF SERVICE
Date

Service was made by me Check one box below to indicate appropriate method of service

G Served personally upon the defendant at: G Left summons at the defendant's dwelling house or usual place of abode with a person of suitable age and
discretion then residing therein and mailed a copy of the summons to the defendant's last known address. Name of person with whom the summons was

G Returned unexecuted:

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 is true and correct.

Returned
Date Name of United States Marshal

(by) Deputy United States Marshal

Remarks:

1

As to who may serve a summons, see Rule 4 of the Federal Rules of Criminal Procedure.