Free Summons Returned Executed - District Court of California - California

Case 3:O7—cv-O2400—SI Document 24 Filed O %
QAO 440 (Rev. lO{93) Summons in a Civil Action 7 * W
RETURN OF SERVICE
_ DATE _ _
Service ofthe Summons and complaint was made by mem
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Check one box be/vw :0 mdicme a ro me merhvd 0 -
n/ed personally upon the defendant. Place where served: I ll 5 d D O
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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:
D Returned unexecuted:
D Other (specify):
STATEMENT OF SERVICE FEES
. TRAVEL SERVICES TOTAL
DECLARATION OF SERVER
I declare under penalty of perjury under the laws ofthe United S tes ofAmerica that the foregoing information
contained in the Return of Service and Statement of Service Fees is true nd correct.
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Executed on '
Date gnalure 0fServer
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Address 0f Server _
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NORTHEHN DlBTR’lil3`l`i O? Citi..1i’Q:i%l~i,i.A
(1) As to who may serve a summons seeliule 4`ofthe Federal Rules ofCivil Procedure.

Case 3:07-cv-02400-SI

Document 24

Filed 09/24/2007

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