AO 83 (Rev. 10/03) Summons in a Criminal CaseUNITED STATES DISTRICT COURTDISTRICT OFUNITED STATES OF AMERICASUMMONS IN A CRIMINAL CASE V.Case Number:(Name and Address of Defendant)YOU ARE HEREBY SUMMONED to appear before the United States District Court at the place, date and time set forth below.PlaceRoomDate and TimeBefore:To answer a(n) G Indictment G Information G Complaint G Probation Violation PetitionG Supervised ReleaseG Violation NoticeViolation PetitionCharging you with a violation of TitleUnited States Code, Section(s)Brief description of offense:Signature of Issuing OfficerDateName and Title of Issuing OfficerAmerican LegalNet, Inc. www.USCourtForms.comAO83 (Rev. 10/03) Summons in a Criminal CaseRETURN OF SERVICEDateService was made by me on:1Check one box below to indicate appropriate method of serviceG Served personally upon the defendant at: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 and mailed a copy of the summons to the defendant's last known address.Name of person with whom the summons was left:G Returned unexecuted: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 onDateName of United States Marshal(by) Deputy United States MarshalRemarks:1 As to who may serve a summons, see Rule 4 of the Federal Rules of Criminal Procedure.American LegalNet, Inc. www.USCourtForms.com
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