REV. 09/2012 1 of 2 UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF NORTH CAROLINA Division Bankruptcy Case Number: IN RE: Debtors: PLAINTIFF(S) v. DEFENDANT(S) ) ) ) ) ) ) Adversary Proceeding Number: SUMMONS IN AN ADVERSARY PROCEEDING YOU ARE SUMMONED and required to submit a motion or answer to the complaint which is attached to this summons to the clerk of the bankruptcy court within 30 days after the date of issuance of this summons, except that the United States and its offices and agencies shall submit a motion or answer to the third-party complaint within 35 days. Clerk, U. S. Bankruptcy Court, Eastern District of North Carolina 1760-A Parkwood Blvd., Wilson, NC 27893 300 Fayetteville St. Mall, P.O. Box 1441, Raleigh, NC 27602-1441 At the same time, you must also serve a copy of the motion or answer upon plaintiff's attorney. Name and Address of Plaintiff's Attorney: If you make a motion, your time to answer is governed by Bankruptcy Rule 7012. IF YOU FAIL TO RESPOND TO THIS SUMMONS, YOUR FAILURE WILL BE DEEMED TO BE YOUR CONSENT TO ENTRY OF A JUDGMENT BY THE BANKRUPTCY COURT AND JUDGMENT BY DEFAULT MAY BE TAKEN AGAINST YOU FOR THE RELIEF DEMANDED IN THE COMPLAINT. Stephanie J. Edmondson, Clerk of Court Date: By: Deputy Clerk American LegalNet, Inc. www.FormsWorkFlow.com 2 of 2 CERTIFICATE OF SERVICE I, (Name) , certify that I am, and at all times during the service of this subpoena was, not less than 18 years of age and not a party to the matter concerning which service of this subpoena was made. I further certify that the service of this summons and a copy of the complaint was made on (Date) by: Mail service: Regular, first class United States mail, postage fully pre-paid, addressed to: Personal Service: By leaving the process with defendant or with an officer or agent of defendant at: Residence Service: By leaving the process with the following adult at: Publication: The defendant was served as follows: [Describe briefly] State Law: The defendant was served pursuant to the laws of the State of as follows: [Describe briefly] (Name of State) 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 Print Name: Signature: Business Address: City: State: Zip Code: American LegalNet, Inc. www.FormsWorkFlow.com