United States Bankruptcy Court for the District of Columbia In re: ____________________________~ Bankruptcy Case No: ____________ Debtor Chapter: __________ __________________________________ Plaintiff v. __________________________________ Defendant Adv. Proceeding No:_____________ SUMMONS IN AN ADVERSARY PROCEEDING YOU ARE SUMMONED and required to submit a motion or answer to the complaint which is attached to this summons to 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 submit a motion or answer to complain within 35 days. Address of the Clerk: Clerk's Office U.S. Bankruptcy Court 333 Constitution Avenue NW Washington, DC 20001 At the same time, you must also serve a copy of the motion or answer upon the plaintiff's attorney. Name and address of Plaintiff's Attorney: If you make a motion, your time to answer is governed by Bankruptcy Rule 7012. YOU ARE NOTIFIED that a scheduling conference in this matter will be held in Courtroom 1, United States Courthouse, 333 Constitution Avenue NW, Washington, DC 20001 on _________________ at ________. IF YOU FAIL TO RESPOND TO THIS SUMMONS, 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. Angela Caesar Clerk of the Bankruptcy Court ______________________ Date By: _____________________________ Deputy Clerk American LegalNet, Inc. www.FormsWorkFlow.com CERTIFICATE OF SERVICE I, ___________________________ (name), certify that I am, and at all times during the 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 _______________ (date) by: Mail Service: Regular, first class United States mail, postage fully pre-paid, addressed to: Personal Service: By leaving the process with defendant or with an officer or agent of the defendant at: Residence Service: By leaving the process with the following adult 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) Under penalty of perjury, I declare the foregoing is true and correct. _____________________ Date _____________________________________ Signature Print Name _______________________________________________________________________ Business Address _______________________________________________________________________ City State Zip American LegalNet, Inc. www.FormsWorkFlow.com