Free Summons Returned Executed as to USA - District Court of California - California

¤ Case 5:OE-cv—O2546-HRL Dodzsirdént |%O` §j£:
E ‘ Department O ustrce · · ..
I _ _ Instructions for Service of Process by the US. Marshal
I - UHIIGKII Stat s Marshals S€I`V1C€ on the reverse of this form.
I · - · ‘ - . ‘ .‘ ‘ - ‘ - -- _- _.-j:rI' --_ ,- =. (Q_; -··· ;:{'·_·,';--_',_':: . I- ']_..!;;;,J.. -'] · .·.Z .-‘ ._ ‘
PLAINTIFF COURT CASE NUMBER
Vladimir Ba;ots · · _ CO7—2546HQRL
DEFENDANT TYPE OF PROCESS
M1chae1 Chertoff, et al rnkgec Below
I
NAMEOF INDIVIDUAL, COMPANY, CORPORATION, ETC., TO SERVE OR DESCRIPTION OF PROPERTYTO SEIZE OR CONDEMN
· Michael Chertoff, Secretary of Department of Homeland of General
I ADDRESS (Street or RFD, Apartment No., City Stare and ZIP Code) l
425 I Street, NH, Washington, DC 20536 _ ._ .
I AT _. _. . _- . . - ._
I SEND NOTICE OF SERVICE COPY TO REQUESTER AT NAME AND ADDRESS BELOW: ` - . . . .
I --—-----— g--·. ---------- ..-.. ---- ·--.. ---- a-4--—| Number of process to be. _ -
- Monica Kane'-. - -. 2 . . -· . .· r.A,‘ -_ . .| _ _ 1 _ -
I , , . _ I __ I .
Jewish Family and Children Services"' · * - *| Numbu ¤I’ Palms IG b¤ "
253Z; Judah Street _ Iserved in this case 6
_ _ ,SH11 Francisco CA 94122 ’ I " " I I I ‘ I n `
I .' ` I . I "‘ ‘‘'`‘ * · n `· -‘ `-'*' ICheck`for service- ‘* I · Y
- - ------ l —... ...-;..-· ...... '-.....;;;; ‘ " on `U.S.A. l 1 -.·
. . ‘ - - ‘· - _- .- -.."tT.`-T?T-T`5.7T.l· . - ;
SPECIAL INSTRUCTIONS OR- OTHER INFORMATION_THAT--WILL ASS_IS_T§ 1jN,-EXPEDITING SERVICE (Im:] regi s; -=~= - A IE, Addresses, All
Fizlophone Numbers, and Estimated. Times Available For Service): ,_ __ _ t _ ` _ ` _' ‘ g ` _- . I gf `‘'` §"*' ‘
**1. Petition and Civil Cover: Sheer; . ·. ·.‘·· .- . 2;. . .. I IUN .9 -.;,n-W :
2. Application to Proceed In Forma Panperis _ _ I `W 7
I 3. ADR Schedu].i11g`0rder '_ I ‘_‘‘ ‘_ " ‘ °` . ··`’ `··` “ ` ‘· ‘ - . K)
4. Order re Application to Proceed II f rm, `ar ` I I I I`- I I " li · I RICHARD W·°WiEKING
I __ n ° auligus cI.ent<.u.s oesratei count I
I ‘ ` · · · -_ " · . ‘ .- - ·· 1 _. - .. .. .:2QI .. - .=`‘ NORTHERN DISTRICT OF CALIFORNIA
BBIZIZY I·I3].I1¤¤ rl il j · - ``·‘ " `--FDEFENDANT "!tO8-535-5513 n i *5/18[2007
I · I FSPACE.BEI.OW-FOR E OF MARSHAL ONLY—gg·— DO NOT VVRITE BELOW THIS LINE
I Iacknowleclge receipt-for the total- ` Total Process District', _= District U Signature of AuthorizedIISMS._Deputy_or Clerk"? I _. _ Date -
number ofprocessindicated. . _ _ _ .. ofOrigin .. to Serve __ I i_ _ `_‘. . .''.`'. I ___` _ '_'' I " `
I (Sign only first USM 285 ifmore I ` "“ - ‘‘‘‘ . J I j' .- '-j*` - ’ · - -
than one USM 285 is submitted) li No. No, \ ‘ ·’‘’ ·r - - ~ " ` *5 07
I . ' rr "`rlr `
I I hereby certify andreturn that I I;] have personally served, ha avelegal-evidence of service, I;]-have executed as shown in "Remarks", the-process described
I on the individual, company, corporation, etc., at the address .hown above or on the individual, co:npany,.corpo1ation, etc., shown at the address inserted below
I
I;] I hereby certify and return that I am unable to locate the individual, company, corporation, etc., named above (See remarks below)
I I Name and title of individual served (lf not shown above) · ` l A person of suitable age and dis-
I . I] cretion then residing in the defendanfs
_ usual place of abode.
Address (complete only ifdifferent.than shown above) Dare gf Service Tim; am
' (·J.·S"“A¤-lvl Pm
Si nature of U.S Marshal or Deputy
` ·-` , I
, .•..ra:-¤§·"
· . 1
. Service.Fee, - Total Mileage Charges Forwarding Fee Total Charges Advance Deposits Amount owed zo U.S, Marshal nf Amount of Refund
‘ _. - · `(including endeavors) ’ .r
Ramarucs; I cn
I 2.8 {2,06-7 Mw IAQ. U. S- Cx-·’*"’•Q¢eJ· 2Q·'L'-‘·"'·- QQS·Q\(* I'-
‘ OCQILSIZQKI II-».Acw-•.¤’— I urowreg
I Ia,.

n PRI0:EE3;';;)N$ _ 1 - . FORM USM-285 (Ren l2Jl5/80)

" Case 5:07-cv—02546-HRL Document 7 Filed 06/27/2007 Page 2 of 3
.. 10/93] Summons in a Civil Action
Umted States DISIYICI Court
NORTHERN DISTRICT OF CALIFORNIA
Viadimir Basotsky SUMMONS IN A CIVIL CASE
i CASE NUMBER: CVO7—02546HRL
[ 7 v.
J Michael Chertoff, etal
‘ TO:
I Michael Chertoff, Secretary Homeland Security -
[ Office of General Counsel I-
425 I Street NW — .
Washington, DC 20536-0003
YOU ARE HEREBY SUMMONED and required to serve upon Pl.A|NT|FF’S ATTORNEY
Monica Kane
i Jewish Family and Children’s Services
2534 Judah Street
San Francisco, CA 94122
an answer to the complaint which is herewith served upon you, within 60 days after service of this summons upon you, exclusive
of the day of service. If you fail to do so, judgement by default will be taken against you for the relief demanded in the complaint.
You must also file your answer with the Clerk of this Court within a reasonable period of time after service.
JQ*=)**°’**m* —_\}Q_U~&@ may is, 2007
ctsnx _. · ‘ ._ _ - o/mz
. dif` dg/Qgzif-pj? - `
2 ett 0 ‘
(avi map I r . cts-RK - ,,.%.4,, gs,
r ERsb$i;@

AO 440(Rw l0,9g;a1slel0§éQl7lgy;Qg1§n46-HRL Document 7 Filed 06/27/2007 Page 3 of 3
RETURN OF SERVICE
" DATE
K Service of the Summons and Complaint was made by me 1 (Xa [ IY G-[
` Name of SERVER (PRINT} TITLE
Dsdwuc is- u ga.; US VM
I Check one box be/ow to indicate appropriate method of service
Q Served Personally upon the Defendant. Place where served:
Q Left copies thereof at the defendants 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:
Q Returned unexecuted:
E other (speary); ?—9·¤*~~*—·¤‘~ <>~*=-·~¤ , ..9 gm cn,
STATEMENT OF SERVICE FEES
TRAVEL SERVICES TOTAL · ‘
I mtr & kiw-
I DECLARATION OF SERVER I -
l declare under penalty of perjury under the laws of the United States of America that the foregoing r
5 information contained in the Return of Service and Statement of Service Fees is true and correct.
Executed on QM ( \ Y] 07 l
Date Signetvrrrsti §trAre.t. rasrmts ssrzvtctz
- _ - 280 sourn rm eraser room 2100
env Joss, cri gsm
Address of Sewer
"T E- '§§°_“‘i. i“"`iZ"i"
txttpita
n (1) As to who may serve a summons see Rule 4 of the Federal Rules of Civil Procedure. n

Case 5:07-cv-02546-HRL

Document 7

Filed 06/27/2007

Page 1 of 3

Case 5:07-cv-02546-HRL

Document 7

Filed 06/27/2007

Page 2 of 3

Case 5:07-cv-02546-HRL

Document 7

Filed 06/27/2007

Page 3 of 3