United States District Court for the Southern District of New York Civil Action, File
Number
A.B., Plaintiff
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Notice and Acknowledgment of Receipt of Summons and Complaint
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v.
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C. D., Defendant
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NOTICE
TO: (insert the name and address of the person to be served.)
The enclosed summons and complaint are served pursuant to Rule 4(c)(2)(C)(ii) of the
Federal Rules of Civil Procedure.
You must complete the acknowledgment part of this form and return one copy of the
completed form to the sender within 20 days. You must sign and date the acknowledgment.
If you are served on behalf of a corporation, unincorporated association (including
a partnership), or other entity, you must indicate under your signature your relationship
to that entity. If you are served on behalf of another person and you are authorized
to receive process, you must indicate under your signature your authority. If you
do not complete and return the form to the sender within 20 days, you (or the party
on whose behalf you are being served) may be required to pay any expenses incurred
in serving a summons and complaint within 20 days. If you fail to do so, judgment
by default will be taken against you for the relief demanded in the complaint. I declare,
under penalty of perjury, that this Notice and Acknowledgment of Receipt of Summons
and Complaint was mailed on (insert date).
Signature
Date of Signature
ACKNOWLEDGMENT OF RECEIPT OF SUMMONS AND COMPLAINT
I declare, under penalty of perjury, that I received a copy of the summons and of
the complaint in the above-captioned manner at (insert address).
Signature
Relationship to Entity/Authority to Receive Service of Process
Date of Signature