the for

E York New of District Southern

43 DOE JANE

Plaintiffs)

. v

MAXWELL, CHISLAINE FPSTFIN FY JEFF GROFF LESLEY

Defendants)

Amended ACTION CIVIL A IN SUMMONS

address) and name (Defendant's To: MAXWELL GHISLAINE

Project Mar Terra do Street 65th East 326 10065 NY York, New

17-cv-616 No. Action Civil

you. against filed been has lawsuit A

you if days 60 or — it) received you day the counting (not you on summons this of service after days 21 Within

Civ. R. Fed. in described States United the of employee or officer an or agency, States United a or States United the are of 12 Rule under motion a or complaint attached the to answer an plaintiff the on serve must you — (3) or (aX2) 12 P. attorney, plaintiff's or plaintiff the on served be must motion or answer The Procedure. Civil of Rules Federal the

are: address and name whose

PP

J.

Lehrman & l.Fistos liling Jaffe

Lute Avenue, Andrews .

33301 FL Lauderdale, Fort

complaint. the in demanded relief the for you against entered be will default by judgment respond, to fail you If

court. the with motion or answer your file must also You

Date:

COURT OF CLERK

Clerk Deputy or Clerk of Signature

Civil Action No. 17-cv-616

## PROOF OF SERVICE

(This section should not be filed with the court unless required by Fed. R. Civ. P. 4 (1))

This summons for (name of individual and title, if any) was received by me on (date)

O I personally served the summons on the individual at (place) on (date) ; or

O I left the summons at the individual's residence or usual place of abode with (name), a person of suitable age and discretion who resides there, on (date), and mailed a copy to the individual's last known address; or

O I served the summons on (name of individual) designated by law to accept service of process on behalf of (name of organization) on (dare) ; or, who is

O I returned the summons unexecuted because ; or

O Other (specify):

My fees are \$ for travel and \$ for services, for a total of \$ 0.00

I declare under penalty of perjury that this information is true.

Date: Server's signature

Printed name and title

Server's address

Additional information regarding attempted service, etc: