Cert of Sv re Smns & Ntc of Pretrial Conf in an Adv Proc (1/16/04) UNITED STATES BANKRUPTCY COURT WESTERN DISTRICT OF TENNESSEE In re Bankruptcy Case No. Chapter Debtor(s). Adversary Proceeding No. Plaintiff(s). Defendant(s). CERTIFICATE OF SERVICE RE SUMMONS AND NOTICE OF PRETRIAL CONFERENCE IN AN ADVERSARY PROCEEDING _________________________________________________________________________________________ I, _______________________________________________________(Name) , 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. I further certify that the service of this summons and a copy of the complaint was made _________________________________________(Date) by: Mail service: Regular, first class United States mail, postage fully pre-paid, addressed to: Electronic Service (in a manner consistent with F.R.C.P. 5(b)(2)(D): 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] Under penalty of perjury, I declare that the foregoing is true and correct. _________________________________ Date Print Name _____________________________________________________________________________________________________ Business Address _______________________________________________ Signature __________________________________________________________________________________________________ City State Zip American LegalNet, Inc. www.FormsWorkFlow.com