AO 83 (Rev 06109) Swnmons in a Criminal Case 

UNITED STATES DISTRICT COURT 

for the 

District of Oregon 

FIL£D24 I'm "16 09:46USDC-cRP 

United States of America 

V. 

WINSTON SHROUT 

Defendant 

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Case No. 3:15-CR-00438-JO 

SUMMONS IN A CRIMINAL CASE 

YOU ARE SUMMONED to appear before the United States district court at the time, date, and place set forth 

below to answer to one or more offenses or violations based on the following document filed with the court: 

0 Indictment ~ Superseding Indictment 0 Information 0 Superseding Information 0 Complaint 

0 Probation Violation Petition 0 Supervised Release Violation Petition 0 Violation Notice 0 Order of Court 

Place: U.S. District Court, Mark 0. Hatfield U.S. Courthouse 

1000 SW Third A venue 

Portland, Oregon 97204 

This offense is briefly described as follows: 

Counts 1-7: 

Counts 8-10: 

Counts 11-13: 

Counts 14-19: 

Fictitious Obligations; 18 U.S.C. § 514(a)(1) 

Fictitious Obligations; 18 U.S.C. § 514(a)(2) 

Fictitious Obligations; 18 U.S.C. § 514(a)(3) 

Willful Failure to File Return; 26 U.S.C. § 7203 

Date: 03,/;b /?G?/,,6 

Immediately upon receipt of this docu 

are to contact the U.S. Pretrial Services 0 · 

(503) 326-8518 for an appointment. 

I declare under penalty of perjury that I have: 

0 Executed and returned this summons 0 Returned this summons unexecuted 

Date: 

Server's signature 

Printed name and title 

Case 3:15-cr-00438-JO Document 22 Filed 03/24/16 Page 1 of 2
AO 83 (Rev. 06/09) Summons in a Criminal Case (Page 2) 

Case No. 3:15-CR-00438-JO 

This second page contains personal identifiers and therefore should 

not be filed in court with the summons unless under seal. 

(Not for Public Disclosure) 

INFORMATION FOR SERVICE 

Name of defendant/offender: \\)\w\St"or\ S ~(OlA-t 

Lastknownresidence: 'i2.:SO N£ A'Z4.\e.a.. s,-. \\:l\~boro' o~ «t1l2.4 

Usual place of abode (if different from residence address): 

If the defendant is an organization, name(s) and address( es) of officer(s) or agent(s) legally authorized to receive service of 

process: 

If the defendant is an organization, last known address within the district or principal place of business elsewhere in the 

United States: 

PROOF OF SERVICE 

Tbis summons was received by me on (date) M (Afc_k \CZ) / lD lk, 

~rsonally served the summons on this defendant \N ~ t\~toV\. S""-r ov.~ (place) L(l.'>O .VE h,?..o.\t c.; ST. \.l.:l\.,\,o(C) o~ on (ckite) 11Aft:~ 23 U>lfo ; or ~~~~~---~~~~~ ......... ~~~~·~~ . at. 

0 On (ckite) 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, and I mailed a copy to the individual's last known address; or 

0 I delivered a copy of the summons to (name of individual) 

who is authorized to receive service of process on behalf of (name of organization) 

on (ckite) and I mailed a copy to ~~~~~~~~~~~~~~~~~~~~- -~~~~~~~-

the organizations's last known address within the district or to its principal place of business elsewhere in the 

United States; or 

0 The summons was returned unexecuted because: 

I declare under penalty of perjury that this information is true. 

Date returned: Hc...<i~ 23 

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Remarks: 

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Case 3:15-cr-00438-JO Document 22 Filed 03/24/16 Page 2 of 2