Free Summons Returned Executed - District Court of California - California

Case 3:O7—cv-O2400—SI Document 27 Filed O9/24/2007 Page 1 of 1
QAO 440 (Rev. 10/93) Summons in a Civil Action 6 7/’ Z [ 5 Y
’ RETURN OF SERVICE
DATE
Service ofthe Summons and complaint was made by mem Q -Z’7 _O 7
Ng-OF SERVER (PRINT) TITLE I
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‘ Check one box below to indie a ro riaite method 0 service
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'Vg’gerved personally&on thgjefendant. Place where served; yy 5 O C/G 3 Z Q (5 ‘
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El 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 were left:
El Retumed unexecuted:
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STATEMENT OF SERVICE FEES
TRAVEL SERVICES TOTAL
DECLARATION OF SERVER
I declare under penalty of perjury under the laws ofthe United States of America that the foregoing information
contained in the Return of Service and Statement of Service Fees is true and correct.
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Address ofServer
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(l) As to who may serve a summons see Rule 4 ofthe Federal Rules ofCivil Procedure.

Case 3:07-cv-02400-SI

Document 27

Filed 09/24/2007

Page 1 of 1