AO 440 (Rev. 06/12) Summons in a Civil Action

UNITED STATES DISTRICT COURT

for the

__________ District of __________ 

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Plaintiff(s)

v. Civil Action No.

Defendant(s)

SUMMONS IN A CIVIL ACTION

To: (Defendant’s name and address)

A lawsuit has been filed against you.

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

are the United States or a United States agency, or an officer or employee of the United States described in Fed. R. Civ.

P. 12 (a)(2) or (3) — 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 plaintiff’s attorney,

whose 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

Southern District of Florida

THE BURLINGTON INSURANCE COMPANY, a

Illinois Corporation

DOCKSIDE VIEW, LLC dba ON THE EDGE BAR &

GRILL, a FL LLC; MICHAEL BRADLEY, as Personal

Representative for Estate of CLAUDIA BRADLEY

MICHAEL BRADLEY as Personal Representative of

the Estate of CLAUDIA BRADLEY

8303 S. INDIAN RIVER DRIVE

FORT PIERCE, FL 34982

MICHAEL A. PACKER, ESQ. 

MARSHALL DENNEHEY WARNER COLEMAN & GOGGIN, P.C. 

2400 EAST COMMERCIAL BLVD., SUITE 1100 

FORT LAUDERDALE, FL 33308 

PHONE # (954) 847-4920

OCTOBER 28, 2022 Southern District of Florida OCTOBER 28, 2022

THE BURLINGTON INSURANCE COMPANY, a

Illinois Corporation

DOCKSIDE VIEW, LLC dba ON THE EDGE BAR &

GRILL, a FL LLC; MICHAEL BRADLEY, as Personal

Representative for Estate of CLAUDIA BRADLEY

MICHAEL BRADLEY as Personal Representative of

the Estate of CLAUDIA BRADLEY

8303 S. INDIAN RIVER DRIVE

FORT PIERCE, FL 34982

MICHAEL A. PACKER, ESQ. 

MARSHALL DENNEHEY WARNER COLEMAN & GOGGIN, P.C. 

2400 EAST COMMERCIAL BLVD., SUITE 1100 

FORT LAUDERDALE, FL 33308 

PHONE # (954) 847-4920

Case 2:22-cv-14368-DMM Document 1-4 Entered on FLSD Docket 10/28/2022 Page 1 of 2
AO 440 (Rev. 06/12) Summons in a Civil Action (Page 2)

Civil Action No.

PROOF OF SERVICE

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

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

’ 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

’ 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:

Server’s signature

Printed name and title

Server’s address

Additional information regarding attempted service, etc:

0.00

Case 2:22-cv-14368-DMM Document 1-4 Entered on FLSD Docket 10/28/2022 Page 2 of 2