Summons In A Civil Action
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PlaintiffDefendant(Defendant?s name and address) 90CHARLES R. DIARD, JR., CLERK OF COURTSignature of Clerk or Deputy Clerk (This section should not be filed with the court unless required by Fed. R. Civ. P. 4 (l))(name of individual and title, if any)(date) (place)(date)(name)(date)(name of individual)(name of organization)(date)(specify):Server?s signaturePrinted name and titleServer?s address