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(Rev. 11/03)

United States Bankruptcy Court
District of In re Bankruptcy Case No. Debtor*
Employer Tax I.D. No. :

SUMMONS TO DEBTOR IN INVOLUNTARY CASE
To the above named debtor: A petition under title 11, United States Code was filed against you on in this bankruptcy court, requesting an order for relief under chapter of the United States Code). YOU ARE SUMMONED and required to submit to the clerk of the bankruptcy court a motion or answer to the petition within 20 days after the service of this summons. A copy of the petition is attached.
Address of Clerk

Of the Bankruptcy Code (title 11

At the same time you must also serve a copy of your motion or answer on petitioner's attorney.
Name and Address of Petitioner's Attorney

If you make a motion, your time to serve an answer is governed by Bankruptcy Rule 1011(c). If you fail to respond to this summons, the order for relief will be entered.

Clerk of the Bankruptcy Court

By:
Deputy Clerk
* Set forth all names, including trade names, used by the debtor within the last 6 years. (Bankruptcy Rule 1005).

Summons to Involuntary Debtor (Reverse) (Rev. 11/03)

CERTIFICATE OF SERVICE
I, (name) , certify that I am, and at all times during the service

of process was, not less than 18 years of age and not a party to the matter concerning which service of process was made. I further certify that the service of this summons and a copy of the complaint was made ___________________ by (date)

G

Mail service: Regular, first class United States mail, postage fully pre-paid, addressed to:

G

Personal Service: By leaving the process with defendant or with an officer or agent of defendant at:

G

Residence Service: By leaving the process with the following adult at:

G

Publication: The defendant was serviced as follows: [Describe briefly]

G

State Law: The defendant was serviced pursuant to the laws of the State of
(name of state)

,

as follows: [Describe briefly]

Under penalty of perjury, I declare that the foregoing is true and correct.

Date
Print Name Business Address City State Zip

Signature