Joint Appendix One

Case 2:10-cv-07678-JFW-DTB Document 1 Filed 10/14/10 Page 32 of 32
AO 440 (Re','. 12:09) Sulml_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 summons foi" (n,mle of imtividual and title, i/any)
was received by me on (date)
Date:
0 1 personally served the summons on the individual at (place)
on (date) ; or
0 I left the summons at the individual's residence or usual place of abode with b,ame)
, a person of suitable age and discretion who resides there,
On {date) , and mailed a copy to the individual's lasr known address; or
I:l I served the sun'unoos on (name ofindividua 0
designated by law to accept service of process on behalf of (name oforganiT.ation)
171 ! returned the summons unexecuted because
0 Other (spec_,),"
My fees are $ for travel and $
I declare under penalty of perjury that this information is true.
Additional intbrmation regarding attempted service, etc:
-A0085-
on (date) ; or
for services, for a total of $ 0.00
Server's signature
Printed name and title
Server_ address
Page ID #:36 I
, who is
; or
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