AO 205 (Rev. 08/09) UNITED STATES DISTRICT COURT for the SUMMONS TO APPEAR TO COMPLETE JUROR QUALIFICATION FORM According to the records of the court, you have failed to complete and return the juror qualification form previously mailed to you. The completion of this form within 10 days is required by section 1864(a) of title 28, United States Code. Accordingly, YOU ARE HEREBY SUMMONED to appear at the date, time and place specified below for the purpose of filling out such juror qualification form. DATE PLACE TIME NOTE: If you do not respond to this summons, an order may be issued by a judge of the court requiring you to appear before the court and show cause for your failure to comply with this summons. A failure to show good cause for noncompliance may result in the imposition of a $1,000 fine, imprisonment for not more than three days, an order to perform community service, or any combination thereof, as provided by section 1864(b) of title 28, United States Code. CLERK (By) DEPUTY CLERK DATE American LegalNet, Inc. www.FormsWorkFlow.com