CSD 2500A [12/01/15] Name, Address, Telephone No. & I.D. No. UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF CALIFORNIA 325 West F Street, San Diego, California 92101-6991 In Re Bankruptcy No. Debtor Adversary No. Plaintiff(s) v. Defendant(s) SUMMONS 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. Address of Clerk Clerk, United States Bankruptcy Court Southern District of California 325 West F Street San Diego, California 92101-6991 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 Federal Rule of Bankruptcy Procedure 7012. 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. Barry K. Lander, Clerk of the Bankruptcy Court Dated: By: , Deputy Clerk CSD 2500A American LegalNet, Inc. www.FormsWorkFlow.com CSD 2500A (Page 2) [12/01/15] CERTIFICATE OF SERVICE I, copy of the complaint was made (name), certify that the service of this summons and a (date) by: Mail Service: Regular, first class United States mail, postage fully pre-paid, addressed to: Personal Service: By leaving the process with the defendant or an officer or agent of the defendant at: Residence Service: By leaving the process with the following adult at: Certified Mail Service on an Insured Depository Institution: By sending the process by certified mail addressed to the following officer of the defendant at: Publication: The defendant was served as follows: [Describe briefly] State Law: The defendant was served pursuant to the laws of the State of [Describe briefly] , as follows: If service was made by personal service, by residence service, or pursuant to state law, I further 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. Under penalty of perjury, I declare that the foregoing is true and correct. [Date] [Signature] Print Name Business Address City State ZIP CSD 2500A American LegalNet, Inc. www.FormsWorkFlow.com