REV. 09/13 UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF NORTH CAROLINA Division In RE: Debtors: Social Security No.: Employer Tax ID No.: Bankruptcy Case No. SUMMONS TO DEBTOR IN INVOLUNTARY CASE To the above named debtor: A petition under title 11, of the United States Code was filed against you on in this court, requesting an order for relief under Chapter of the Bankruptcy Code. Date YOU ARE SUMMONED and required to submit to the clerk of the bankruptcy court a motion or answer to the petition within 21 days after the service of this summons. A copy of the petition is attached. Clerk, U. S. Bankruptcy Court, Eastern District of North Carolina P.O. Box 791, Raleigh, NC 27602 At the same time you must also serve a copy of your motion or answer on petitioner's attorney. Name and Address of Petitioner's Attorney If you make a motion, your time to serve an answer is governed by Bankruptcy Rule 1011(c). If you fail to respond to this summons, the order for relief will be entered. Stephanie J. Edmondson, Clerk of Court Date By: Deputy Clerk *Set forth all names, including trade names, used by the debtor within the last 6 years. (Bankruptcy Rule 1005). For joint debtors, set forth both social security numbers. American LegalNet, Inc. www.FormsWorkFlow.com CERTIFICATE OF SERVICE (Name) Date I, , certify that on I served this summons and a copy of the involuntary petition on (Name) the debtor in this case, by [describe the mode of service and the address at which the debtor was served]: 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: Signature: Print Name: Business Address: American LegalNet, Inc. www.FormsWorkFlow.com