Fill and Sign the 0500 Summons in a Civil Action Form

AO 440 (Rev. 05/00) Summons in a Civil Action UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF ILLINOIS SUMMONS IN A CIVIL CASE CASE NUMBER: V.ASSIGNED JUDGE: DESIGNATED MAGISTRATE JUDGE: TO: (Name and address of Defendant) YOU ARE HEREBY SUMMONED and required to serve upon PLAINTIFF’S ATTORNEY (name and address) an answer to the complaint which is herewith served upon you, withindays after service of this summons upon you, exclusive of the day of service. If you fail to do so, judgment 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. MICHAEL W. DOBBINS, CLERK (By) DEPUTY CLERKDATE AO 440 (Rev. 05/00) Summons in a Civil Action RETURN OF SERVICE Service of the Summons and complaint was made by me(1)DATE NAME OF SERVER (PRINT)TITLE Check one box below to indicate appropriate method of service GServed personally upon the defendant. Place where served: GLeft 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: GReturned unexecuted: GOther (specify): STATEMENT OF SERVICE FEES TRAVELSERVICESTOTAL DECLARATION OF SERVER I declare under penalty of perjury under the laws of the United States of America that the foregoing information contained in the Return of Service and Statement of Service Fees is true and correct. Executed on DateSignature of Server Address of Server (1) As to who may serve a summons see Rule 4 of the Federal Rules of Civil Procedure.