United States Bankruptcy Court Eastern District of Wisconsin IN RE: Debtor(s). Case No: Chapter: Plaintiff(s). vs. All documents regarding this matter must be identified by both adversary and bankruptcy case numbers Adversary No: Defendant(s). CERTIFICATE OF SERVICE REGARDING SUMMONS 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 on (date) by one of the following methods: Mail Service: Regular, first class United States mail, and postage fully prepaid. (List names/addresses below.) Personal Service: By leaving the process with defendant or with an officer or agent of defendant. (List names/addresses below:) Residence Service: By leaving the process with an adult. (List names/addresses below.) Certified Mail Service on an Insured Depository Institution: By sending the process by certified mail addressed to the following officer of the defendant. (List names/addresses below.) Publication: The defendant was served as described in the space below. State Law: The defendant was served pursuant to the laws of the State of (U.S. state), as described in the space below. LIST NAMES AND ADDRESSES OR BRIEF DESCRIPTION OF HOW DEFENDANT WAS SERVED: Under penalty of perjury, I declare that the foregoing is true and correct. Business Address, City, State, and Zip Signature Printed Name Date Print Form American LegalNet, Inc. www.FormsWorkFlow.com