AO 440 (Rev. 01/09) Summons in a Civil Action - MIWD (Rev. 07/15) SUMMONS IN A CIVIL ACTION UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF MICHIGAN Case No. Hon. v. TO: ADDRESS: A lawsuit has been filed against you. YOU ARE HEREBY SUMMONED and required to serve upon plaintiff, an answer to the attached com plaint or a motion under Rule 12 of the Federal Rules of Civil Procedure within days after service of this sum mons on y ou (not counting the day you received it). If y ou fail to respond, judgment by default will be entered against you for the relief demanded in the complaint. You must also file your answer or motion with the Court. The Court has offices in the following locations: 399 Federal Building, 110 Michigan St., NW, Grand Rapids, MI 49503 P.O. Box 698, 314 Federal Building, Marquette, MI 49855 107 Federal Building, 410 W. Michigan Ave., Kalamazoo, MI 49007 113 Federal Building, 315 W. Allegan, Lansing, MI 48933 PLAINTIFF OR PLAINTIFF'S ATTORNEY NAME AND ADDRESS CLERK OF COURT By: Deputy Clerk Date PROOF OF SERVICE This summons for (name of individual and title, if any) was received by me on (date) . I personally served the summons on the individual at on . (date) (place where served) I left the summons at the individual's residence or usual place of abode with of suitable age and discretion who resides there, on I served the summons on of process on behalf of I returned the summons unexecuted because Other (specify) My fees are $ Date: Additional information regarding attempted service, etc.: for travel and $ (date) (name) , a person , and mailed a copy to the individual's last known address. , who is designated by law to accept service on (date) (name of individual) (name of organization) . . . for services, for a total of $ . I declare under the penalty of perjury that this information is true. Server's signature Server's printed name and title Server's address American LegalNet, Inc. www.FormsWorkFlow.com