AO 441 (Rev. DC - 9/25/03) Third Party Summons in a Civil Action UNITED STATES DISTRICT COURT District of Columbia PLAINTIFF THIRD PARTY SUMMONS IN A CIVIL ACTION V. DEFENDANT AND THIRD PARTY PLAINTIFF Case Number: V. THIRD PARTY DEFENDANT To: Name and address of Third Party Defendant YOU ARE HEREBY SUMMONED and required to serve on PLAINTIFF’S ATTORNEY (name and address) DEFENDANT AND THIRD-PARTY PLAINTIFF’S ATTORNEY (name and address) an answer to the third-party complaint which is served on you with this summons, within days after the service of this summons on you, exclusive of the day of service. If you fail to do so, judgment by default may be taken against you for the relief demanded in the third-party complaint. There is also served on you with this summons a copy of the complaint of the plaintiff. You have the option of answering or not answering the plaintiff’s complaint, unless (1) this is a case within Rule 9(h) Federal Rules of Civil Procedure, and (2) the third-party plaintiff is demanding judgment against you in favor of the original plaintiff under the circumstances described in Rule 14(c) Federal Rules of Civil Procedure, in which situation you are required to make your defenses, if any, to the claim of plaintiff as well as to the claim of the third-party plaintiff. Any answer that you serve on the parties to this action must be filed with the Clerk of this Court within a reasonable period of time after service. CLERK (By) DEPUTY CLERK DATE American LegalNet, Inc. www.FormsWorkFlow.com AO 441 (Rev. DC - 9/25/03) Third Party Summons in a Civil Action RETURN OF SERVICE Service of the Summons and complaint was made by me(1) NAME OF SERVER DATE TITLE Check one box below to indicate appropriate method of service G Served personally upon the third-party defendant. Place where served: G Left copies thereof at the third-party defendant’s dwelling house or usual place of abode with a person of suitable age and discretion then residing therein. Name of person with whom the summons and complaint were left: G Returned unexecuted: G Other (specify): STATEMENT OF SERVICE FEES TRAVEL SERVICES TOTAL DECLARATION OF SERVER I declare under penalty of perjury under the laws of the United States of America that the foregoing information contained in the Return of Service and Statement of Service Fees is true and correct. Executed on Date Signature of Server Address of Server (1) As to who may serve a summons see Rule 4 of the Federal Rules of Civil Procedure. American LegalNet, Inc. www.FormsWorkFlow.com