Fill and Sign the Summons in a Civil Actioncentral District of California Form

CV-21 (02/04) NOTICE AND ACKNOWLEDGMENT OF RECEIPT OF SUMMONS AND COMPLAINT UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIA PLAINTIFF(S) v. DEFENDANT(S). CASE NUMBER NOTICE AND ACKNOWLEDGMENT OF RECEIPT OF SUMMONS AND COMPLAINT (For use with State Service only) To : The summons and complaint served herewith are being served pursuant to R\ ule 4(e)(1) of the Federal Rules of Civil Procedure and Section 415.30 of the California Code of Civil Procedure. You may complete the acknowledgment part of this form and return the com\ pleted form to the sender within twenty (20) days. If you are served on behalf of a corporation, unincorporated association\ including a partnership, or other entity, you must indicate under your signature your relationship to that entity and \ your authorization to receive process for that entity. If you are served on behalf of another person and you are autho\ rized to receive process, you must indicate your authority under your signature. IF YOU DO NOT complete and return the form to the sender within twenty (20) days, y\ ou (or the party on whose behalf you are being served), may be required to pay any expenses incur\ red in serving a summons and complaint in any other manner permitted by law. IF YOU DO complete and return this form, you (or the party on whose behalf you a\ re being served), must answer the complaint within the time provided in Rule 12 of the Federal Rules of Ci\ vil Procedure or judgment by default may be taken against you for the relief demanded in the complaint. I declare, under penalty of perjury, that this Notice and Acknowledgment\ of Receipt of Summons and Complaint was mailed on . Signature of Sender ACKNOWLEDGMENT OF RECEIPT OF SUMMONS AND COMPLAINT (To be completed by recipient) I declare under penalty of perjury, that I received a copy of the summon\ s and complaint in the above-captioned matter at on Address Date Signature Relationship to Entity/Authority to Receive Service of Process