Joint Appendix One

• Case2:10-cv-07678-JFW-DTB Document1 Filed10/14/10 Page30of32
AO 440 IRev. 12/09) Sumn_ons in a Civil Action (Page 2)
Civil Action No.
PROOF OF SERVICE
(This section should not be filed with the court unless required by Fed. R. Cir. P. 4 (I))
This sununons for (name of indivi_h:al and title, _f any)
was received by me on (date)
Date:
I personally served the summons on the individual at (#lace)
on (date) ; or
ID [ left the summons at the individual's residence or usual place of abode with (nun!e)
, a person of suitable age and discretion who resides there,
on (date) , and mailed a copy to the individual's tastknown address; or
O I served the summons on (name of individual)
designated by law to accept service of process on behalf of (name oforgani:ation)
CI I returned the summons unexecuted because
CI Other (specifi,):
on (date) ; or
My fees are $ for travel and $ for services, for a total of $ 0.00
I declare under penalty of perjury that this information is true.
Additional infonnation regarding attempted service, etc:
-A0083-
Ser_'er's signature
Printed name and title
Ser_,er_ address
Page ID #:34 !
, who is
; or
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