Fill and Sign the B 250c Form

Address of Clerk Name and Address of Plaintiff' s Attorney B 250C (8/96)United States Bankruptcy Court _______________ District Of _______________ In re _______________________________________________, ) Debtor )Case No. ___________________ ) ) Chapter ____________________ _______________________________________________, ) Plaintiff )) v. ) _______________________________________________, )Adv. Proc. No. ______________ Defendant ) SUMMONS AND NOTICE OF TRIAL IN AN ADVERSARY PROCEEDING YOU ARE SUMMONED and required to file a motion or answer to the complaint which is attached to this summons with the clerk of the bankruptcy court within 30 days after the date of issuance of this summons, except that the United States and its offices and agencies shall file a motion or answer to the complaint within 35 days. At the same time, you must also serve a copy of the motion or answer upon the plaintiff's attorney. If you make a motion, your time to answer is governed by Fed. R. Bankr. P. 7012. YOU ARE NOTIFIED that a trial of the proceeding commenced by the filing of the complaint will be held at the following time and place. Address Room Date and Time IF YOU FAIL TO RESPOND TO THIS SUMMO NS, YOUR FAILURE WILL BE DEEMED TO BE YOUR CONSENT TO ENTRY OF A JUDGMENT BY THE BANKRUPTCY COURT AND JUDGMENT BY DEFAULT MAY BE TAKEN AGAINST YOU FOR THE RELIEF DEMANDED IN THE COMPLAINT. _______________________________________________________Clerk of the Bankruptcy Court ______________________________________ By:______________________________________________________ Date Deputy Clerk CERTIFICATE OF SERVICE I, ___________________________________________, certify that I am, and at all times during the (name) service of process was, not less than 18 years of age and not a party to the matter concerning which service of process was made. I further certify that the service of this summons and a copy of the complaint was made _________________________ by: (date) Ma il Serv ice: R egula r, first clas s Un ited Sta tes ma il, posta ge fu lly pre- paid, addr essed to: Perso nal S ervice : By le aving the pro cess w ith defe ndan t or w ith an o fficer o r agen t of def enda nt at: Res idenc e Ser vice: B y leav ing the proc ess w ith the fo llow ing ad ult at: Certified Mail Service on an Insured Depository Institution: By sending the process by certified mail addressed to the follow ing o fficer o f the de fend ant at: Publication: The defendant was served as follows: [Describe briefly] State Law: The defendant was served pursuant to the laws of the State of ________________________, as follows: [Describe briefly] (name of state) Un der p enalty of per jury, I d eclare that the foreg oing is true an d cor rect. ____________________________________ _________________________________________________________________ Date Signature Print Name Business Address City State Zip