USM-285 is a 5-part form. Fill out the form and print 5 copies. Sign as needed and route as specified below.

• US Department of Justice PROCESS RECEIPT AND RETURN United States Marshals Service

PLAINTIFF

COURT CASE NUMBER EDUARDO R. PEREZ

2:1 5-cv-76

DEFENDANT

TYPE OF PROCESS

RAYMOND E. HOLT, et al

COMPLAINT AND ORDER

NAME OF INDIVIDUAL, COMPANY, CORPORATION. ETC. TO SERVE OR DESCRIPTION OF PROPERTY TO SEIZE OR CONDEMN

SERVE Raymond E. Holt, Reg. Administrative Appeal Coordinator, Federal Bureau of Prisons

AT ADDRESS (Street or RFD, Apartment No., City, State and ZIP Code)

320 First St., NW, Washington, DC 20534

SEND NOTICE OF SERVICE COPY TO REQUESTER AT NAME AND ADDRESS BELOW I Number of process to be

served with this Form 285 2

r uardo R. Perez 65875-004 FCI Jesup 2680 U.S. Hwy., 301 South

L- (IA 31599

Number of parties to be served in this case

Check for service on U.S.A.

S

SPECIAL INSTRUCTIONS OR OTHER INFORMATION THAT WILL ASSIST IN EXPEDITING SERVICE (Include Business and ,1 (tern ate Addresses, All Telephone Numbers, and Estimated Times Available for Service):

Fold

Per Order of the Court dated 12/31/15.

Signature of Attorney other Originator requesting service on behalf of: PLAINTIFF TELEPHONE NUMBER

DATE

Scott L. Poff, Clerk

D DEFENDANT

912-280-1330

12/31/15

SPACE BELOW FOR USE OF U.S. MARSHAL ONLY-- DO NOT WRITE BELOW THIS LINE I acknowledge receipt for the total number of process indicated. (Sign only for USM 285 if more thern one USM 285 is submitted)

Total Process District of District to Origin I Serve

No._..._ I No.

Signature of Authorized USMS Deputy or Clerk I Date

I hereby certify and return that I have personally served . have legal evidence of service, El have executed as shown in Remarks', the process described on the individual , company, corporation, etc. • at the address shown above on the on the individual . company, corporation, etc. shown at the address inserted below.

El I hereby certify and return that I am unable to locate the individual, company, corporation, etc. named above (See remarks below)

Name and title of individual served (((not shown above)

Address (complete only different than shown above)

D A person of suitable age and discretion then residing in defendant's usual place of abode

Date Time am

El pot

Signature of U.S. Marshal or Deputy

Service Fee

Total Mileage Charges Forwarding Fee Total Charges Advance Deposits

Amount owed to U.S. Marshals or including endeavors)

(Amount of Refund*)

REMARKS:

I. CLERK OF THE COURT 2. USMS RECORD 3. NOTICE OF SERVICE 4. BILLING STATEMENT: To be returned to the U.S. Marshal with payment,

if any amount is owed. Please remit promptly payable to U.S. Marshal. 5. ACKNOWLEDGMENT OF RECEIPT

PRIOR EDITIONS MAY BE USED

Form USM-285 Rev. 12115/80

Automated 01/00

Perez v. Watts et al Doc. 9 Att. 1

Dockets.Justia.com

USM-285 is a 5-part form. Fill out the form and print 5 copies. Sign as needed and route as specified below.

U.S. Department of Justice PROCESS RECEIPT AND RETURN United States Marshals Service

PLAINTIFF

COURT CASE NUMBER EDUARDO R. PEREZ

2:15-cv-76

DEFENDANT

TYPE OF PROCESS

RAYMOND E. HOLT, et a!

COMPLAINT AND ORDER

NAME OF INDIVIDUAL, COMPANY, CORPORATION. ETC. TO SERVE OR DESCRIPTION OF PROPERTY TO SEIZE OR CONDEMN

SERVE Suzanne R. Hastings, (Retired) Warden FCI Jesup

AT ADDRESS (Street or RFD, Apartment No., City. State and ZIP Code)

2680 US Hwy 301 South, Jesup, GA 31599 SEND NOTICE OF SERVICE COPY TO REQUESTER AT NAME AND ADDRESS BELOW

uardo R. Perez 65875-004 FCI Jesup 2680 U.S. Hwy., 301 South

GA 11599

Number of process to be served with this Form 285 1 2

Number of parties to be served in this case

Check for service on U.S.A.

SPECIAL INSTRUCTIONS OR OTHER INFORMATION THAT WILL ASSIST IN EXPEDITING SERVICE (Include Business and.4 F/era ate ,1(ldrcsses,

All Telephone Numbers, and Estimated Times Available for Service):

Fold Fold

Per Order of the Court dated 12/31/15.

Signature of Attorney other Originator requesting service on behallof:

L PLAINTIFF TELEPHONE NUMBER

DATE

Scott L. Poff, Clerk

LI DEFENDANT

912-280-1330

12/31/15

SPACE BELOW FOR USE OF U.S. MARSHAL ONLY-- DO NOT WRITE BELOW THIS LINE I acknowledge receipt for the total

Total Process District of

District to Signature of Authorized USMS Deputy or Clerk Date

number of process indicated. Origin

Serve (Stgn only for USM285 if more than one (ISM 285 is submitted)

No. No..._ -

I hereby certify and return that 1 0 have personally served .0 have legal evidence of service, F] have executed as shown in "Remarks', the process described on the individual , company, corporation, etc., at the address shown above on the on the individual company, corporation, etc. shown at the address inserted below.

LI I hereby certify and return that I am unable to locate the individual, company, corporation, etc. named above (See remarks below)

Name and title of individual served (if not shown above) LI A person of suitable age and discretion then residing in defendant's usual place of abode

Address (complete only different than shown above) Dale Time [jam EIPitt

Signature of U.S. Marshal or Deputy

Service Fee Total Mileage Charges Forwarding Fee Total Charges Advance Deposits Amount owed to U.S. Marshal' or including endeavor)

(Amount of Refund*)

REMARKS:

I. CLERK OF THE COURT 2. USMS RECORD 3. NOTICE OF SERVICE 4. BILLING STATEMENT': To be returned to the U.S. Marshal with payment.

if any amount is owed. Please remit promptly payable to U.S. Marshal. 5. ACKNOWLEDGMENT OF RECEIPT

PRIOR EDITIONS MAY BE USED

Form USM-285 Rev. 12/15/80

Automated 01/00

USM-285 is a 5-part form. Fill out the form and print 5 copies. Sign as needed and route as specified below.

U.S. Department of Justice PROCESS RECEIPT AND RETURN United States Marshals Service

PLAINTIFF

COURT CASE NUMBER EDUARDO R. PEREZ

2:1 5-cv-76

DEFENDANT

TYPE OF PROCESS

RAYMOND E. HOLT, et al

COMPLAINT AND ORDER

NAME OF INDIVIDUAL, COMPANY, CORPORATION. ETC. TO SERVE OR DESCRIPTION OF PROPERTY TO SEIZE OR CONDEMN

SERVE John V. Flournoy, Warden FCI Jesup AT ADDRESS (Street or RFD, Apartment Na, City, State and ZIP Code)

2680 US Hwy 301 South, Jesup, GA 31599 SEND NOTICE OF SERVICE COPY TO REQUESTER AT NAME AND ADDRESS BELOW

Eduardo R. Perez __... 65875-004

FCI Jesup 2680 U.S. Hwy., 301 South

L~~nn, GA U599

Number of process to be served with this Form 285 1 2

Number of parties to be served in this case

Check for service on U.S.A.

SPECIAL INSTRUCTIONS OR OTHER INFORMATION THAT WILL ASSIST IN EXPEDITING SERVICE (Inchde Business and ,lltern ate Addresses, All Telephone Numbers, and Estimated Times Available for Service):

Fold

Fold

Per Order of the Court dated 12/31/15.

Signature of Attorney other Originator requesting service on behalf of:

FJ PLAINTIFF TELEPHONE NUMBER

DATE

Scott L. Poff, Clerk

El DEFENDANT

912-280-1330

12/31/15

SPACE BELOW FOR USE OF U.S. MARSHAL ONLY— DO NOT WRITE BELOW THIS LINE

I acknowledge receipt for the total number of process indicated. (Sign only for USM 285 ifmore than one USM285 is submitted)

Total Process District of District to Origin I Serve

No....__ INc.

Signature of Authorized USMS Deputy or Clerk I Date

I hereby certify and return that I U have personally served ,LI] have legal evidence of service, [I] have executed as shown in 'Remarks', the process described on the individual, company, corporation, etc., at the address shown above on the on the individual . company, corporation, etc. shown at the address inserted below.

Q. I hereby certify and return that I am unable to locate the individual, company, corporation, etc. named above (See remarks below)

Name and title of individual served (tfnc,i shown above)

Address (complete only d ifferent than shown above)

U A person of suitable age and discretion then residing in defendant's usual place of abode

Date Time U am

LI pm

Signature of U.S. Marshal or Deputy

Service Fee

Total Mileage Charges Forwarding Fee Total Charges Advance Deposits Amount owed to U.S. Marshal* or

including endeavors)

(Amount of Refunds)

REMARKS:

1. CLERK OF THE COURT 2. USMS RECORD 3. NOTICE OF SERVICE 4. BILLING STATEMENT*: To be returned to the U.S. Marshal with payment,

if any amount is owed. Please remit promptly payable to U.S. Marshal. 5. ACKNOWLEDGMENT OF RECEIPT

PRIOR EDITIONS MAY BE USED

Form USM-285 Rev. 12/15180

Automated 01/00

U.S. Department of Justice United States Marshals Service

PROCESS RECEIPT AND RETURN

PLAINTIFF

COURT CASE NUMBER EDUARDO R. PEREZ

2:15-cv-76

DEFENDANT

TYPE OF PROCESS

RAYMOND E. HOLT, et al

COMPLAINT AND ORDER

NAME OF INDIVIDUAL, COMPANY, CORPORATION. ETC, TO SERVE OR DESCRIPTION OF PROPERTY TO SEIZE OR CONDEMN

SERVE Ken Harris, Jr., Chaplain Supervisor, FCI Jesup AT ADDRESS (Street or RFD, Apartment No., City, Stale and ZIP Code)

-. 2680 US Hwy 301 South, Jesup, GA 31599 SEND NOTICE OF SERVICE COPY TO REQUESTER AT NAME AND ADDRESS BELOW I Number of process to be

--1

served with this Form 2t5 1 2

Eduardo R. Perez 65875-004 FCI Jesup 2680 U.S. Hwy., 301 South

L—lemin. CiA 11599

SPECIAL INSTRUCTIONS OR OTHER INFORMATION THAT WILL ASSIST IN EXPEDITING SERVICE (Inei(de Business nirdAltern ale Addresses, All Telephone Numbers, andEstimaled Times AvallableforServlce):

Fold Fold

Per Order of the Court dated 12/31/15.

Signature of Attorney other Originator requesting service on behalf of:

L) PLAINTIFF TELEPHONE NUMBER

DATE

Scott L. Poff, Clerk

LII DEFENDANT

912-280-1330

12/31/15

SPACE BELOW FOR USE OF U.S. MARSHAL ONLY— DO NOT WRITE BELOW THIS LINE I acknowledge receipt for the total

Total Process District of District to

Signature of Authorized IJSMS Deputy or Clerk I Date

number of process indicated. Origin Serve

IS only for USM285 if more than one USM 285 is submitted)

No............. INo.

I hereby certify and return that I 0 have personally served .0 have legal evidence of service, 0 have executed as shown in 'Remarks', the process described on the individual , company, corporation, etc., at the address shown above on the on the individual , company, corporation, etc. shown at the address inserted below.

0 I hereby certify and return that lam unable to locate the individual, company, corporation, etc. named above (See remarks below)

Name and title of individual served (if not shown above)

Address (complete only different than shown above)

0 A person of suitable age and discretion then residing in defendant's usual place

of abode

Date Time 1:1 ant

LI pin

Signature of U.S. Marshal or Deputy

Service Fee

Total Mileage Charges Forwarding Fee Total Charges Advance Deposits

Amount owed to U.S. Marshal* or

including endeavors)

(Amount of Refund*)

Number of parties to be served in this case

5

Check for service on U.S.A.

REMARKS:

1. CLERK OF THE COURT 2. USMS RECORD 3. NOTICE OF SERVICE 4. BILLING STATEMENT: To be returned to the U.S. Marshal with payment,

if any amount is owed. Please remit promptly payable to U.S. Marshal. 5. ACKNOWLEDGMENT OF RECEIPT

PRIOR EDITIONS MAY BE USED

Form USM-285 Rev. 12/15/80

Automated 01/00

U.S. Department of Justice PROCESS RECEIPT AND RETURN United States Marshals Service

PLAINTIFF

COURT CASE NUMBER EDUARDO R. PEREZ

2:1 5-cv-76

DEFENDANT

TYPE OF PROCESS

RAYMOND B. HOLT, eta!

COMPLAINT AND ORDER

NAME OF INDIVIDUAL, COMPANY, CORPORATION. ETC. TO SERVE OR DESCRIPTION OF PROPERTY TO SEIZE OR CONDEMN

SERVE Sam Kirchoff, Chaplain, FCI Jesup

AT ADDRESS (Street or RFD, Apartment No., City, Stale and ZIP Code)

2680 US Hwy 301 South, Jesup, GA 31599 SEND NOTICE OF SERVICE COPY TO REQUESTER AT NAME AND ADDRESS BELOW Number of process to be

served with this Form 285 1 2

Eduardo R. Perez 65875-004 FCI Jesup 2680 U.S. Hwy., 301 South

L"• GA 11599

Number of parties to be served in this case

Check for service on U.S.A.

5

SPECIAL INSTRUCTIONS OR OTHER INFORMATION THAT WILL ASSIST IN EXPEDITING SERVICE (Inc/side Business andAltern ate Addresses. All Telephone Numbers, and Estimated Times Available for Service):

Fold Fold

Per Order of the Court dated 12/31/15.

Signature of Attorney other Originator requesting service on behalf of;

91 PLAINTIFF TELEPHONE NUMBER

DATE

Scott L. Poff, Clerk

Li DEFENDANT

912-280-1330

12/31/15

SPACE BELOW FOR USE OF U.S. MARSHAL ONLY-- DO NOT WRITE BELOW THIS LINE I acknowledge receipt for the total number of process indicated. (Sign only for USM 285 ifmore than one USM 285 is submitted)

Total Process District of District to Origin I Serve

No............. INo.

Signature of Authorized USMS Deputy or Clerk I Date

I hereby certify and return that I Li have personally served , Li have legal evidence of service, Li have executed as shown in "Remarks', the process described on the individual . company, corporation, etc., at the address shown above on the on the individual , company, corporation, etc. shown at the address inserted below.

Li I hereby certify and return that I am unable to locate the individual, company, corporation, etc. named above (See remarks below)

Name and title of individual served (f not shown above) Li A person of suitable age and discretion then residing in defendants usual place of abode

Address (complete only different than shown above)

Date Time Li arts

Li pm

Signature of U.S. Marshal or Deputy

Service Fee

Total Mileage Charges Forwarding Fee Total Charges Advance Deposits

Amount owed to U.S. Marshal' or including endeavors)

(Amount of Refund')

REMARKS:

1. CLERK OF THE COURT 2. USMS RECORD 3. NOTICE OF SERVICE 4. BILLING STATEMENT': To be returned to the U.S. Marshal with payment,

if any amount is owed. Please remit promptly payable to U.S. Marshal. 5. ACKNOWLEDGMENT OF RECEIPT

PRIOR EDITIONS MAY BE USED

Form USM-285 Rev. 12/15/80

Automated 01/00