Free Waiver of Service Executed - District Court of Connecticut - Connecticut

I
_ Case 3:O3—cv—OO61 -AVC Document 9_ Filed O1/12/2004 Page 1 of 1 I
’ A I ii uno aw (nw. mes) e' . -
WAIVER OF SERVICE OF SUMMONS
I [iq) ii l.) I-\
(-_~— ri, ® ii ith. j 1
I TO: »
. (NAME or PL.·\IN'I'lFF’S Arronmiv on UNREPRESENTED PLA1N?}I§P A i
_ · un Jin 12 F3 3: 21 QI
I, I U.,} i . , i1Ci (DI€1’1EN1).·\. NAM .) U is e I1 i iiic in C li {Hi l i
. qi] E»,—r;~-*.-1 at-\.'. ‘,__ I
··-——. i·PiL`.i' {itil L, .
that I waive service of summons in the action of I .. h%\•a.& - Q5 E
_ P · an on or criom ep ..... . .. 1
' "" in Ti 1i
which is case number tcd Statcs{E®istiii5t Court ji i
(occur NUMBER) l1`ii.`i ‘ fi ·1 ·r-_’ 5 : I
‘ . . i -·~·, im`: E i
for the DIST.1'lC{0f S G5 1 Obi ;€
"" we 1*11 i l
I have also received a copy ofthe complaint in the action, two copies*of this instrument, a -— »- 1;
which I can retum the signed waiver to you without cost to me. ii}1 " 1;;; -
C? ` .1;
—··· ‘ " -
I agree to save the cost of service of ar summons and an additional copy oi` the complaint SQ tliiiiiiawsuit
E by not requiring that I (or the entity on whose behalf I am acting) be served with judicial processm the manner y
` provided by Rule 4. - t
I (or the entity on whose behalf I am acting) will retain all defenses or objections to the lawsuit or to the
jurisdiction or venue of the court except for objections based on a defect in the summons or in the service of { Q
the summons.
I understand that a judgment may be entered against me (or the party on whose behalf I am acting) if an `
answer or motion under Rule 12 is not served upon you within 60 days after Q 5 IQGV Z |§§}3 ,
_ _ _ (DATE tusoussr was ssim g Q
, or within 90 days after that date if the request was sent outside the United States. . i
i gre) (stem >
Printedffyped Name; UOGLY & C\`{Y\S‘€?._
As l *f"\ of — Im
(rum; ( iwoiurrs ¤t=.r=sm:>Am7 Q
‘ U E
Duty to Avoid Unnecessary Costs of Service of Summons
Rule 4 of the Fedml Rules of Civil Procedure requires certain parties to eooperate in saving unnecessary eests of service ofthe summons and
complaint. A defendant located in the United States who, ath: being notilied of an action andssked by a plaintiff located in the`UnitedSLit¤s to waive ‘ ii
serviceofsummons,hilatodescwillberwxprircdtobcutlneoostofmrchservieeunlessgoodcauscbeshounforitsfailuretosigriantdretumlltepvaivcr.
Itisnotgcodcausefcraliiluretnwaives¤vioedutaputybeIicv¤H¤1dwmmplaintisw1fmmded,¤rU¤1¤1ea¤.im1hai been brought inan li
impeepezplaeeerinac¤unlha1lad summen;reuinnlldd`¤¤esmd¤bjedimm(cu¤q¤mynl¤k1gmdwmnunm¤ut0dws¤vioccf0wmmnsm¤) mduuylalsrebjeettethejuyisdietien *
_ 0fuH®\Ift¢l{0uIG§II®WhHBI}Hl•¤I(l1hlIb0¢¤k\lIQ|‘I. V E
_ ‘ A-ckfendutwhowaiveuuvicemuawjthinllrstinssqaeciliedonlhuwaiv¤rf¤¢ms¤v¤hnthcp|aimiI1`aa¤mney(orumepreieruedpIahliH)a I ._
¢¤p¤a¤mu»e¤mpt•immd¤¤¤•h¤6Ic_adg•¤dmyyofd»¢¤pu¤¤wh!r¤»¤m¤1. Hmamwummhmummmmmumamqn ‘ li
judgnqmmybeukeaagnirudmdcfutdaru. Bywdvhgmvicmadcfudamkdhmdmwetinmmamwwmmduummnemtudbemnuudly
. 1*
1 1;
. - • ' ,, . 4 _ . ‘ it
I ‘ lil

1E I
R . - L- ij. ei . . _f,;?’§T '
Q jfg jf. . so " ’T‘TTj§iif? i i€ ; T; ’?f- i '
Q ` Y f " ` I "` """ it i`i‘. i ` ` ”" ‘ * ‘ ¢ we · · —··- " - " - f i ;;>;;;h~—i ·¤·»·-sasgjjj i