UNITED STATES DISTRICT COURT EASTERN DISTRICT OF TEXAS Beaumont _________________ DIVISION SUMMONS IN A CIVIL CASE v. CASE NUMBER: TO: (Name and address of defendant) YOU ARE HEREBY SUMMONED and required to serve upon PLAINTIFF'S ATTORNEY (name and address) an answer to the complaint which is herewith served upon you, within __________days after service of this summons upon you, exclusive of the day of service. If you fail to do so, judgment by default will be taken against you for the relief demanded in the complaint. You must also file your answer with the Clerk of this Court with a reasonable period of time after service. DAVID J. MALAND, CLERK BY:_____________________________________ Date: Deputy Clerk American LegalNet, Inc. www.FormsWorkFlow.com RETURN OF SERVICE Service of the summons and complaint was made by me : Date Name of Server Title __ Check one box below to indicate appropriate method of service G Served personally upon the defendant. Place where served: _________________________________________________________ G Left summons at the defendant's dwelling house or usual place of abode with a person of suitable age and discretion then residing therein. Name of person with whom the summons was left: _________________________________________________________________ G Returned unexecuted: STATEMENT OF SERVICE FEES Travel _______________________ Services ____________________ Total _______________________________________________________________________________________ DECLARATION OF SERVER I declare under penalty of perjury under the laws of the United States of America that the foregoing information contained in the Return of Service is true and correct. Returned on ___________________________________ Date _______________________________________ Signature of Server ________________________________________ ________________________________________ Address of Server American LegalNet, Inc. www.FormsWorkFlow.com