Summons In A Social Security Case

) ) ) ) ) Plaintiff Civil Action No. v. ,Acting Commissioner of Social Security Defendant To: COMMISSIONER OF SOCIAL SECURITY Office of the Regional Chief Counsel Region III, Philadelphia 300 Spring Garden Street, 6th Floor Philadelphia, PA 19123 (1 copy) ATTORNEY GENERAL OF THE UNITED STATES United States Department of Justice 950 Pennsylvania Avenue, NW Washington, DC 20530 (1 copy) UNITED STATES ATTORNEY FOR THE SOUTHERN DISTRICT OF WV Post Office Box 1713 Charleston, WV 25326 (1 copy) A lawsuit has been filed against you. Within 60 days after service of this summons on you (not counting the day you received it), you must serve on the plaintiff an answer to the attached complaint or a motion under Rule 12 of the Federal Rules of Civil Procedure. The answer or motion must be served on the plaintiff or plaiwhose name and address are: If you fail to respond, judgment by default will be entered against you for the relief demanded in the complaint. You also must file your answer or motion with the court. CLERK OF COURT Date: Signature of Clerk or Deputy Clerk American LegalNet, Inc. www.FormsWorkFlow.com Civil Action No. (This section should not be filed with the court unless required by Fed. R. Civ. P. 45.) This summons for (name of individual and title, if any) was received by me on (date) . I personally served the summons on the individual at (place) on (date) ; or ce or usual place of abode with (name) , a person of suitable age and discretion who resides there, on (date) , and mailed a copy I served the summons on (name of individual) , who is designated by law to accept service of process on behalf of (name of organization) on (date) ; or I returned the summons unexecuted because ; or Other (specify): . My fees are $ for travel and $ for services, for a total of $ . I declare under penalty of perjury that this information is true. Date: Printed name and title Additional information regarding attempted service, etc: American LegalNet, Inc. www.FormsWorkFlow.com