U.S. Department of Justice United States Marshals Service PLAINTIFF DEFENDANT PROCESS RECEIPT AND RETURN See "Instructions for Service of Process by U.S. Marshal" COURT CASE NUMBER TYPE OF PROCESS SERVE AT { NAME OF INDIVIDUAL, COMPANY, CORPORATION. ETC. TO SERVE OR DESCRIPTION OF PROPERTY TO SEIZE OR CONDEMN ADDRESS (Street or RFD, Apartment No., City, State and ZIP Code) SEND NOTICE OF SERVICE COPY TO REQUESTER AT NAME AND ADDRESS BELOW Number of process to be served with this Form 285 Number of parties to be served in this case Check for service on U.S.A. SPECIAL INSTRUCTIONS OR OTHER INFORMATION THAT WILL ASSIST IN EXPEDITING SERVICE (Include Business and Alternate Addresses, All Telephone Numbers, and Estimated Times Available for Service): Fold Fold Signature of Attorney other Originator requesting service on behalf of: PLAINTIFF DEFENDANT TELEPHONE NUMBER DATE SPACE BELOW FOR USE OF U.S. MARSHAL ONLY-- DO NOT WRITE BELOW THIS LINE I acknowledge receipt for the total number of process indicated. (Sign only for USM 285 if more than one USM 285 is submitted) Total Process District of Origin No. District to Serve No. Signature of Authorized USMS Deputy or Clerk Date I hereby certify and return that I have personally served , have legal evidence of service, have executed as shown in "Remarks", the process described on the individual , company, corporation, etc., at the address shown above on the on the individual , company, corporation, etc. shown at the address inserted below. I hereby certify and return that I am unable to locate the individual, company, corporation, etc. named above (See remarks below) Name and title of individual served (if not shown above) A person of suitable age and discretion then residing in defendant's usual place of abode Date Time am pm Address (complete only different than shown above) Signature of U.S. Marshal or Deputy Service Fee Total Mileage Charges Forwarding Fee including endeavors) Total Charges Advance Deposits Amount owed to U.S. Marshal* or (Amount of Refund*) REMARKS: DISTRIBUTE TO: 1. CLERK OF THE COURT 2. USMS RECORD 3. NOTICE OF SERVICE 4. BILLING STATEMENT*: To be returned to the U.S. Marshal with payment, if any amount is owed. Please remit promptly payable to U.S. Marshal. 5. ACKNOWLEDGMENT OF RECEIPT PRIOR EDITIONS MAY BE USED American LegalNet, Inc. www.FormsWorkFlow.com Form USM-285 Rev. 11/13