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

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Case 3:03-cv 00232-DFM Document 39 Filed 06/07/2005 P? 1 of 4 I
U S Dc artmem Of Ju icc _ __ PROCESS RECEIPT AND TURN I
’ _ ' P I _ ’" See Instructions for "Service of Process by the U.S. Marshal" ·
, United States Marshals Service on the reverse of rar form. I
PLAINTIFF Bfistcut Boufg non COURT CASE NUMBER
I - A
I 303cv 232 (RNC) (OFM) I
DEFENDANT I TYPE OF PROCESS
John ,3, A;-mg; I Ong, at ar, 2nd Amended Complaint
SERVE NAWE INDIVI h' AL, COMPANY, CORPORATION, ETC., TO SERVE OR DESCRIPTION OF PROPERTY T0 SEIZE OR CONDEMN
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· · P • ‘ • • sr I
ADDRESS (Street •` RFD, Apartment N0., City Stare and ZIP Code) I
AT Corrrigar I Radgovrski. Correctional finer
°Z• In n L- as no 1 n . ` e I.! 2 I
.$.E&'.*Ll`L0'.EQ€.9£ SEWER QOBLT .EE22E§.“*`.E*L/E SWE £l`L?..*5.'2Di**¥°·§*i*?!)E;-| Number of process to be I
F I I served with this Form — 285 1
Brietout: Bo I rg uig non I ‘!'
macdougal I Correctioanal final: IN"'“*’°¥ °f P“’"“S ‘° *’°
1.153 Bam; feet S Iserved In this case
SufEl.e}.Clr CT 06078 I _
I Check for service
_________ ___,,,_ ____ __________ ________ __________ ______ Ion U.S.A.
SPECIAL INSTRUCTIONS OR OTI-IER INFORMATION THAT WILL ASSIST IN EXPEDITING SERVICE (Include Business and Aitemate Addresses, All I
Telephone Numbers, and Estimated Time Available For Service): I
E EEE
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Personally Serve / IFP/ Individaul capacity
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Signature of Attomey or other Originator uesting service on behalf of: -I:PLAlNTIFF 5;];/lB§;61 DATE4 21 r
R. Jaiman El oaranoaur rl " / /0** I
SPACE BELOW FOR *_l OF U.S. MARSHAL ONLY — DO NOT WRITE BELOW THIS LINE
I acknowledge receipt for the total Total rocess District District Signature of Authorized USMS Deputy or Clerk Date I
number of process indicated. of Origin to Serve `
(Sign only first USM 285 if more ( / ""‘
than one USM 285 is submitted) No. KL No. A _ -1 * · A dc? O`:)
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I hereby certify and return that bil ave pe onally served, El have legal evidence of servlce, [J have executed as shown in "Remarks", the process described I
on the individual, company, corporation, et I ., at the address shown abovc or on the individual, company, corporation, etc., shown ar the address inserted below. I
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l;-l l hereby certifylahli r*etu1i't'iC.'tIIILI5I am I nable to locate the individual, company, corporation. ctc., named above (See remarks below)
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Name a e of in`H`i`vidua| 'selved (if n t shown above) I A person of suitable age and dis-
,,, · I _ 6-//l"? Jl l;l cretion then residing in the defendant's
L `QIJI }_,.Zf' ` { _.€`€C;A,,% usual place of abode. I
Addres ( omplete on `ifdiffereritfttlgn sh above) Date of Service Time am I
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"·""” Q Signature of U.S. Marshal or Deputy r
I?-* CK2:] ¤/.!zL.,·· 7i!€C@ £(,rCc', I
Service Fee Total Mileage Charges Forwarding Fee Total Charges Advance Deposits Amount owed to U.S. Marshal or Amount of Refund
. (including endeavors) I
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PRIOR EDITIONS ER · ‘ I2/I5/80) I
my BE USED 1. CL K OF THE COURT wr {II, '_I;,C_;,
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"°“° mc"' W S“&":"`5%ZS ?€H§?E% 002a2;AoFM Document as Filed 06/07/2005 Page 2 er 4 Q
I RETURN OF SERVICE .
Service was made by me on l Date I
Name of Server {print) Title
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Check one box be/ow to rnd are appropriate method of service I
El Served personally upon the defendant at: I
!
El Left copies there at the defendants dwelling, house or usual place of abode with a person of suitable
age and discretio then residing therein.
Name of person ith whom the summons and complaint were left: e
I;] R€U.lI"l'1SC] UFTGXBC BCIZ
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El Other {specify}: I J
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I STATEMENT OF SERVICE FEES 2
rrmvet I siaevicss romt
I DECLARATION OF SERVER
I declare unde penalty of perjury under the laws of the United States of America that the I
foregoing information ontained in the Return of Service is true and correct. Q

Executed on: I __,,,,___ _____ I
Date Signature of Server l
Address of Server
i
ll As to who may serve a summons see Rule 4 of he Federal Rules of Criminal Procedure. I
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I U S Dc QI&32—DF|V| D0CUm€VltBROCESSjREI@E!B9p5\NB¥.ETUid€ I
' _ ' p _ t — ‘ .. See Instructions for "Service of Process b the U.S. Marshal" I
I I " I
I Umted States Marshals Service on the reverse of me form. I
. I
PLAINTIFF I COURT casa NUMBER I
Bristout Bon: nigon 3:O3ev232(RNC)(DFMO
I DEFENDANT I TYPE OF PROCESS
I John J. Arm 2nd Amended complaint
l?ME OF INDIVI ?· UAL, COMPANY, CORPORATION, ETC., TO SERVE OR DESCRIPTION OPPROPERTY TO SEIZE OR CONDEMN
I {J ·- entree I - ·
I » ADDRESS. (Street I» RFD, Apartment No., City State and ZIP Code)
I Comsttgan I' adgowslu Correctional Insst
AT 986 Norw ich New Lond T ker Uncasvillei CT 06078
EEEEEOEQBESEEEESOEL 'EEBEEETEILIE MM2 &l`IPéEDBl2$§.E£‘?@LV;-I Nambe, gf pmcggg ,0 bg A
F I I served with this Form - 285
Brsistout B urguiqon II 265860 » -
I -
rdt·hcDoug . Coicicectonal Inst INumber of panics to be
lfl.53 east Street S |s¤¤t¢d in this cass I
I Suffield. C'}? 06078 . I I
Check for service
I on U S A
SPECIAL INSTRUCTIONS OR OTHE INFORMATION THAT WILL ASSIST IN EXPEDITING SERVICE (Include Business and Altemate Addresses, All
Figgephone Numbers, and Estimated Tim Available For Service):
I Fold
IFP / P.€l?`SOna]J~Y QVVE / individual capacity I
I
I “ I
Signature of Attorney or other Originator ·'I• uesting service on behalf of: III PLAINTIFF TELEPHONE NUMBER DATE.
III oaranunlvr ` I
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SPACE BELOW FOR U E OF U.S. MARSHAL ONLY — DO NOT WRITE BELOW TI-IIS LINE
I acknowledge receipt for the total Total Process District District Signature of Authorized USMS Deputy or Clerk Date
number of process indicated. I of Origin to Serve I
(Sign only Hrs: USM 285 iCmon·: l~— I . ,»· I
than one USM 285 is submittlsfl) I No. M No. J ‘· 4 _.i.t,r_;__ (K 6) 0:9 I
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I hereby certify aut? turn th ` P1 aI;e·` onally served, G have legal evidence of service, [I have executed as shown in "Remarks", the process described
*2... .,
on the individualf pany, tgporation, II II, at the address shown above or on the individual, company. corporation, etc., shown at the address inserted below.
nas a: j- ~ I
I] I hereby cenifyI nd ret[;rH that 'nable to locate the individual, company. corporation. ctc., named above (See remarks below)
Name and tiileso ndividua1:z:§ervcd§;_ ij;n t shown above) E A person of suitable age and dis-
·· : r cretion then residing in the defendant's -
A Y · - »-· ·b*°a'*·•/ J, C ¢€__ €'}`»•7*{ usual place of abode.
Address (complete only ifdl nt th§!1`§ ·"} above) Date of Service Time am Q
:;> .
t { as 2 ex I
’ Signature of U.S. Marshal or Deputy
P"" 1 I
I s.. ‘ _ I
ervice Fee _· Total Mileage Charges Forwarding Fee Total Charges Advance Deposits Amount owed to U.S. Marshal or Amo 3 tof Reitihd
(including endeavors) ' __' -. ` I
ef "/ - [ cj lv`; »*· ‘* .»-IT?
REMARKS: I I @2* I
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¤’¤¤¤¤ Enmms 1. CLERK or me counr mm U ”’ tm """°°* I
MAY BE USED I
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I "°4"0"`9"` W" S“E`:"`§Ee ?€`éI:’%?‘E$ir 002s2-Dlalvl I Document se Filed 06/07/2005 Page 4 er 4 rr
I if- ~ vp`}- I
I * RETURN OF SERVICE
Service was made by me 0 I Date
Name of Server (print) I Title
Check one box below to in ate appropriate method of service
El Served personally upon the defendant at:
III Left copies there at the defendant's dwelling, house or usual place of abode with a person of suitable U
age and discretio then residing therein.
Name of person ith whom the summons and complaint were left: I
III Returned unexec ed: I
* ` l
El Other (specify}; 2
I
I i
I STATEMENT OF SERVICE FEES I
TRAVEL I SERVICES TOTAL
I DECLARATION OF SERVER I
I
I declare unde penalty of perjury under the laws of the United States of America that the I
foregoing information i-ontained in the Return of Service is true and correct. I
Executed on: I .. ,,.. _. _.... I
Date Signature of Server I
i
Address of Server I
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I
I
1} As to who may serve a summons sea Rule 4 of he Federal Rules of Criminal Procedure.
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