B2500E (Form 2500E) (12/15) United States Bankruptcy Court District Of In re Debtor* , ) ) ) ) Case No. Chapter SUMMONS TO DEBTOR IN INVOLUNTARY CASE To the above named debtor: A petition under title 11, United States Code was filed against you in this bankruptcy court on (date), requesting an order for relief under chapter of the Bankruptcy Code (title 11 of the United States Code). YOU ARE SUMMONED and required to file with 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. Address of the clerk: 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 answer is governed by Fed. R. Bankr. P. 1011(c). If you fail to respond to this summons, the order for relief will be entered. (Clerk of the Bankruptcy Court) Date: By: (Deputy Clerk) * Set forth all names, including trade names, used by the debtor within the last 8 years. (Fed. R .Bankr. P. 1005). American LegalNet, Inc. www.FormsWorkFlow.com B2500E (Form 2500E) (12/15) CERTIFICATE OF SERVICE I, (name), certify that on (date), 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 Print Name: Signature Business Address: American LegalNet, Inc. www.FormsWorkFlow.com