Fill and Sign the 801 Summons in a Civil Action Form

OAO 440 (Rev. 8/01) Summons in a Civil Action UNITED STATES DISTRICT COURT Central District of California SUMMONS IN A CIVIL CASE V. CASE NUMBER: TO: (Name and address of Defendant) YOU ARE HEREBY SUMMONED and required to serve on PLAINTIFF’S ATTORNEY (name and address) an answer to the complaint which is served on you with this summons, withindays after service of this summons on 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. Any answer that you serve on the parties to this action must be filed with the Clerk of this Court within a reasonable period of time after service. CLERKDATE (By) DEPUTY CLERK OAO 440 (Rev. 8/01) 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.