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Case 8:23-cv-00504-DOC-DFM Document 8 Filed 03/21/23 Page 2 of 2 Page ID #:177 <br /> AO 440(Rev.O6/12) Summons in a Civil Aotion(Page 2) <br /> Civil Action No. <br /> PROOF OF SERVICE <br /> (This section should not be ftled with the court unless required by Fed.R. Civ. A 4 (l)) <br /> This summons for(name of individual and title, if any) <br /> was received by me on(date) <br /> I1 I personally served the summons on the individual at(place) <br /> On(date) ; or <br /> 173 I left the summons at the individual's residence or usual place of abode with(name) <br /> , a person of suitable age and discretion who resides there, <br /> on(date) , and mailed a copy to the individual's last known address; or <br /> 171 I served the summons on(name of individual) ,who is <br /> designated by law to accept service of process on behalf of(name of organization) <br /> on(date) ;or <br /> I I returned the summons unexecuted because ; or <br /> 0 Other(sped): <br /> My fees are$ for travel and$ for services,for a total of$ 0.00 <br /> I declare under penalty of perjury that this information is true. <br /> Date: _ <br /> Server's signature <br /> Printed name and title <br /> Server's address <br /> Additional information regarding attempted service, etc: <br /> i <br />