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

District of Oregon

CARRIE MEDINA,

3:15-cv-00232-BR

CITY OF PORTLAND, CITY OF GRESHAM,

TRI-COUNTY METROPOLITAN

TRANSPORTATION DISTRICT OF OREGON,

OFFICER TAYLOR LETSIS, et al.,

City of Portland

Office of City Attorney

Tracy P. Reeve

1221 SW 4th Ave., Ste. 430

Portland, OR 97204

Charles J. Paternoster, Parsons Farnell & Grein, LLP, 1030 SW Morrison St.,

Portland, OR 97205

Alan J. Galloway, Tim Cunningham, Davis Wright Tremaine, LLP, 1300 SW Fifth Ave.,

Ste. 2400, Portland, OR 97201

02/13/2015 By: s/C.Brost, Deputy Clerk

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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) .

u I personally served the summons on the individual at (place)

on (date) ; or

u 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

u 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

u I returned the summons unexecuted because ; or

u 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:

3:15-cv-00232-BR

0.00

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AFFIDAVIT OF SERVICE 

UNITED STATES DISTRICT COURT 

District of Oregon 

Case Number: 3:15-CV-00232-BR 

Plaintiff: 

CARRIE MEDINA 

vs. 

Defendant: 

CITY OF PORTLAND; et al. 

For: 

DAVIS WRIGHT TREMAINE LLP 

1300 S.W. 5th Ave. 

Suite 2300 

Portland, OR 97201 

Received by BARRISTER SUPPORT SERVICE, INC. on the 13th day of February, 2015 at 8:34am to be 

served on CITY OF PORTLAND C/0: TRACY P. REEVE, CITY ATTORNEY, 1221 SW 4TH AVE., STE. 430, 

PORTLAND, OR 97204. 

I, Wayne Savage, being duly sworn, depose and say that on the 13th day of February, 2015 at 4:02pm, 1: 

SERVED the within named PUBLIC AGENCY by delivering a true copy of the SUMMONS; COMPLAINT, CIVIL 

CASE ASSIGNMENT ORDER; DISCOVERY AND PRETRIAL SCHEDULING ORDER; FED. R. CIV. P. 26(a) 

DISCOVERY AGREEMENT; CONSENT TO JURISDICTION BY A MAGISTRATE JUDGE AND DESIGNATION 

OF THE NORMAL APPEAL ROUTE; CIVIL CASE MANAGEMENT TIME SCHEDULES to DARLA ENG as 

OPERATION STAFF SUPPORT of the within named agency authorized to accept service of process. 

I declare under penalty of perjury that I am a resident of the State of Oregon. I am a competent person 18 

years of age or older and not a party to or attorney in this proceeding and am authorized to serve the process 

described herein. I certify that the person, firm, or corporation served is the identical one named in this action. I 

am not a party to nor an officer, director, or employee of, nor attorney for any party, corporate or otherwise. 

Subscribed and Sworn to before me on the 16th day 

of February, 2015 in the county of Mullnomah by 

~;C?q;;r-mm. NOTYPUBLIC 

of OREGON 

~ 

~ 

BARRISTER SUPPORT SERVICE, INC. 

11349 SW 60th Ave. 

Portland, OR 97219-6754 

(503) 246-8934 

Our Job Serial Number: TSB-2015001115 

Ref: 200835/1 

Service Fee: $85.00 OFFICIAL STAMP 

DAVID CARL COEY 

NOTARY PUBLIC ·OREGON 

COMMISSION NO. 929667 

MY COMMISSION EXPIRES JULY 17,2018 Copyright© 1992-2011 Database Services, Inc.- Process Server's Toolbox V6.5n 

1111111111111111111111111111111111111 

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