CSD 2500E [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. Tax I.D.(EIN)#: /S.S.#: XXX-XX- _____ Debtor* SUMMONS TO DEBTOR IN INVOLUNTARY CASE A petition under Title 11, United States Code, was filed against you on Bankruptcy Court, requesting an order for relief under Chapter Code). YOU ARE SUMMONED and required to file with the Clerk of the Bankruptcy Court a motion or answer to the petition within 21 days after the service of this summons. A copy of the petition is attached. , 20 , in this of the Bankruptcy Code (Title 11 of the United States 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 petitioner's attorney. Name and Address of Petitioner's Attorney If you make a motion, your time to answer is governed by Fed.R.Bankr.P. 1011(c). IF YOU FAIL TO RESPOND TO THIS SUMMONS, THE ORDER FOR RELIEF WILL BE ENTERED. Barry K. Lander, Clerk of the Bankruptcy Court Dated: By: , Deputy Clerk _____________________________________________________________________________________________ *Set forth all names, including trade names, used by the debtor within the last 8 years. (Fed.R.Bankr.P. 1005). American LegalNet, Inc. www.FormsWorkFlow.com CSD 2500E CSD 2500E (Page 2) [12/01/15] CERTIFICATE OF SERVICE I, (name), certify that on (date), I served this summons and a copy of the involuntary petition on (name), the debtor in this case, by [describe the mode of service and the address at which the debtor was served]: 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 2500E American LegalNet, Inc. www.FormsWorkFlow.com