B250A (rev 03/2007) UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF INDIANA In Re: Case Number: Debtor(s) Plaintiff(s) vs. Adversary Case Number: Defendant(s) CERTIFICATE OF SERVICE REGARDING SUMMONS 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 on _________________________ (date) by one of the following methods: Mail Service: Regular, first class United States mail, and postage fully pre-paid. (List names/addresses below.) Personal Service: By leaving the process with defendant or with an officer or agent of defendant. (List names/addresses below.) Residence Service: By leaving the process with an adult. (List names/addresses below.) Certified Mail Service on an Insured Depository Institution: By sending the process by certified mail addressed to the following officer of the defendant. (List names/addresses below.) Publication: The defendant was served as follows in the space below. State Law: The defendant was served pursuant to the laws of the State of _______________ (U. S. state), as follows in the space below. LIST NAMES AND ADDRESSES OR BRIEF DESCRIPTION OF HOW DEFENDANT WAS SERVED: Under penalty of perjury, I declare that the foregoing is true and correct. Signature Date Business Address Business City, State, and Zip American LegalNet, Inc. www.FormsWorkFlow.com