Case 6:16-cv-06825-FPG Document 1 Filed 12/17/16 Page 1 of 11

UNITED STATES DISTRICT COURT

WESTERN DISTRICT OF NEW YORK
ASHLEIGH WHEELER AND JERAH BREWSTER,
individually and as representatives of the class,
v.

Plaintiffs,

WEGMANS FOOD MARKETS, INC.,

CLASS ACTION COMPLAINT

AND DEMAND FOR JURY TRIAL
Civil Action No.

Defendant.

16-cv-06825

Ashleigh Wheeler and Jerah Brewster, on behalf of themselves and the class set forth

below (Plaintiffs), by and through their attorneys Thomas & Solomon LLP, bring this class

action complaint against Wegmans Food Markets, Inc. (referred to as Wegmans or

Defendant).
1.

NATURE OF ACTION

This putative class action is brought pursuant to the Fair Credit Reporting Act

(FCRA). Defendant routinely violated the FCRAs core protections by procuring or causing

to be procured consumer and/or investigative consumer reports, as those terms are defined by
the FCRA (herein referred to collectively as background report(s) or consumer report(s)),
on employees and job applicants without making a legally required stand-alone disclosure.
2.

Using the services of a third party, Wegmans routinely obtains and relies on

3.

Given the determinative role that consumer reports can play regarding an

the information in the consumer report to evaluate prospective and current employees.

applicants employment prospects, employers are required to ensure that all applicants are
aware of the employers intention to procure a background check.

Case 6:16-cv-06825-FPG Document 1 Filed 12/17/16 Page 2 of 11

4.

Specifically, the FCRA provides that an employer or prospective employer

cannot procure, or cause a consumer report to be procured, for employment purposes with
respect to any consumer, unlessa clear and conspicuous disclosure has been made in writing

to the consumer at any time before the report is procured or caused to be procured, in a
document that consists solely of the disclosure, that a consumer report may be obtained for
employment purposes. 15 U.S.C. 1681b(b)(2)(A)(i)(emphasis added).
5.

Pursuant to the FCRA, applicants have a right to both obtain a copy of their

consumer reports and to have errors in their reports corrected. See 15 U.S.C. 1681g,
1681i. In order for applicants to exercise those rights, it is essential that consumers are aware

that a report is going to be procured so that, if they choose, they can request a copy of the
report to proactively ensure that it does not contain any errors.

JURISDICTION AND VENUE

6.

This Court has subject matter jurisdiction pursuant to 28 U.S.C. 1331

7.

Venue is proper in this District because Defendant does business here, and at

because this action involves a federal question.

least one Plaintiff resides here and applied for a position within the District.
Plaintiffs
8.
9.

PARTIES

Plaintiff Ashleigh Wheeler (Wheeler) is a resident of Rochester, New York.

On or about April 2013, Ms. Wheeler applied to work at Wegmans through

their standard online application.

10.
11.

Shortly thereafter, Ms. Wheeler began working as a cashier for Wegmans.

Plaintiff Jerah Brewster is a resident of Ithaca, New York.
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Case 6:16-cv-06825-FPG Document 1 Filed 12/17/16 Page 3 of 11

12.

On or about October 2015, Mr. Brewster applied to work at Wegmans through

13.

Shortly thereafter, Mr. Brewster began working for Wegmans as a pharmacy

their standard online application.

technician, and then later worked as a coffee shop attendant.

Defendant

14.

Defendant Wegmans Food Markets, Inc. is a domestic business corporation

15.

Further, Defendant Wegmans Food Markets, Inc. is a private family-owned

16.

Defendant Wegmans Food Markets, Inc. is a regional supermarket chain with

registered in New York.

company founded and headquartered in Rochester, New York.

approximately 90 stores across New York, Pennsylvania, New Jersey, Virginia, Maryland, and

Massachusetts. Defendant Wegmans Food Markets, Inc. also includes five signature
restaurants-Amore, The Burger Bar, Market Caf, Next Door Bar & Grill, and the Pub.
people.

17.

Defendant Wegmans Food Markets, Inc. employs approximately 46,000

18.

In 2015, Wegmans Food Markets, Inc. had annual sales of $7.9 billion.

19.

At all relevant times, Defendant Wegmans Food Markets, Inc. has overseen

the hiring process of all of their locations.

20.

For example, Wegmans Food Markets, Inc. requests background checks on

behalf of potential employees, including Plaintiffs Wheeler and Brewster.

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Case 6:16-cv-06825-FPG Document 1 Filed 12/17/16 Page 4 of 11

FACTS

Defendants Failure To Make A Proper Disclosure In Violation Of The FCRA

21.

Plaintiffs Brewster and Wheeler completed Wegmans standard electronic

documents relating to their anticipated employment, including an electronic authorization to

conduct a background check.
22.

Wegmans online authorization causes a background check to be procured by a

23.

Wegmans background check authorization contains liability release language

third party company.

stating:

I hereby release Wegmans, my former employers, and all other persons or

entities contacted by Wegmans from any and all claims, demands, or liabilities
arising out of or in any way related to the release, disclosure, and use of such
information.
24.

The inclusion of the release provisions in connection with its background

25.

At the bottom of the page, an applicant must include their e-signature agreeing

disclosure violates the FCRA.

to the background check authorization. Further, an applicant must complete the e-signature
in order to complete the application.
26.

In completing Wegmans documentation, Plaintiffs Brewster and Wheeler

27.

Wegmans online documentation and authorization fails to include a clear and

included their e-signatures.

conspicuous disclosure, in a document consisting solely of the disclosure, that Wegmans

would cause a consumer report to be procured.
28.

By including a release with the disclosure, Defendant willfully disregarded this

regulatory guidance and violated 15 U.S.C. 1681b(b)(2)(A)(i).

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Case 6:16-cv-06825-FPG Document 1 Filed 12/17/16 Page 5 of 11

29.

As such, Plaintiffs Brewster and Wheeler were misled as to the nature and

30.

Despite its failure to provide applicants, including Plaintiffs Wheeler and

purpose of their consent and their rights.

Brewster, with the required stand-alone disclosure, Wegmans subsequently procured a

consumer report, or caused a consumer report to be procured on Plaintiffs Wheeler, Brewster,

and the Class.
31.

Pursuant to the FCRA, applicants have a right to both obtain a copy of their

consumer reports and to have errors in their reports corrected. See 15 U.S.C. 1681g,
1681i. In order for applicants to exercise those rights, it is essential that consumers are aware

that a report is going to be procured so that, if they choose, they can request a copy of the
report to proactively ensure that it does not contain any errors.
32.

Not aware of their ability to do so, Plaintiffs Wheeler and Brewster did not

33.

Thus, Defendant willfully violated 15 U.S.C. 1681b(b)(2)(A)(i) by procuring

request a copy of the consumer report that was procured by Defendant,

a consumer report, or causing a consumer report to be procured, on Plaintiffs, including

Plaintiffs Wheeler and Brewster, for employment purposes without first providing a clear and

conspicuous written disclosure, in a document consisting solely of the disclosure, that a

consumer report may be obtained for employment purposes.
34.

Additionally, as a result of Defendants violation, Plaintiffs Wheeler and

Brewster were not only misled by Defendant, but they were subject to a significant invasion
of privacy that could jeopardize their personal reputation as well as financial well-being.

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Case 6:16-cv-06825-FPG Document 1 Filed 12/17/16 Page 6 of 11

Facts Relating to Defendants Willful, Systematic and Repeated FCRA Disclosure Violation
35.

Similar to Plaintiffs Wheeler and Brewster, Wegmans, through the services of a

third party, conducts background checks on other job applicants as part of its standard
screening process.
36.

Wegmans relies on consumer reporting agencies to obtain this information and

37.

The online documentation completed by applicants does not contain a clear

report it. These reports constitute consumer reports for purposes of the FCRA.

and conspicuous written disclosure to the consumer, in a document that consists solely of the
disclosure, that a consumer report may be obtained by Wegmans for employment purposes,

but Wegmans routinely requests and procures reports from a third party about applicants
and employees in spite of this fact.
form.

38.

For example, the documentation includes a liability waiver in the disclosure

39.

The language of the FCRA with respect to the stand alone disclosure

40.

The Federal Trade Commission (FTC) confirms that [t]he inclusion of such

requirement is clear. See 15 U.S.C. 1681b(b)(2)(A)(i).

a [liability] waiver in a disclosure form will violate [the FCRA], which requires that a

disclosure consist solely of the disclosure that a consumer report may be obtained for
employment purposes. See Exhibit A.
41.

Further, courts have routinely confirmed that the failure to include the stand

alone disclosure is a violation of the protection afforded to employees under the FCRA. See
Reardon v. Closetmaid Corp., 2:08-CV-01730, 2013 WL 6231606, at *9 (W.D. Pa. Dec. 2,
2013 (in granting summary judgment to the class, court found employers willful violation of
-6-

Case 6:16-cv-06825-FPG Document 1 Filed 12/17/16 Page 7 of 11

the FCRA based on employers inclusion of a liability release in a document purporting to

constitute the required stand-alone disclosure); Singleton v. Dominos Pizza, LLC, CIV.A. DKC
11-1823, 2012 WL 245965 (D. Md. Jan. 25, 2012) (Ultimately, both the statutory text and
FTC advisory opinions indicate that an employer violates the FCRA by including a liability
release in a disclosure document).
42.

By systematically inserting a liability release, Wegmans willfully violated 15

U.S.C. 1681b(b)(2)(A).

43.

CLASS ACTION ALLEGATIONS

Plaintiffs bring the claims pursuant to Federal Rule of Civil Procedure 23

(Rule 23). The Rule 23 class consists of the following (Class): All employees and job
applicants in the United States who were the subject of a consumer report that was procured

or caused to be procured by Wegmans within five years of this complaint and through the
date of final judgment in this action.
23(a).

44.

The class action is maintainable under subsections (1), (2), (3) and (4) of Rule

45.

Numerosity is met because the Class size is believed to be over 40 members.

Wegmans regularly has consumer reports procured by a third party in order to evaluate

employees and job applicants. Further Wegmans uses the information in the consumer

reports to evaluate employees and job applicants. The size and scale of Wegmans operations

ensures that the number of members in the class will be in the tens of thousands. The names
and addresses of the Class members are available from Defendants records.
46.

Common issues of law and fact exist as to all members of the Class. The

Plaintiff and the Class members were all individuals who applied to work for Wegmans and a
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Case 6:16-cv-06825-FPG Document 1 Filed 12/17/16 Page 8 of 11

background check was procured by a third party at the request of Wegmans. The common
issues of law and fact also include the following:

47.

Whether Defendant obtained or caused to be procured background checks on

employees and job applicants;

Whether Defendant violated the FCRA by causing consumer reports to be

procured without providing the proper disclosure;
Whether Defendants FCRA violation was willful;

The proper measure of statutory and punitive damages; and

The proper form of declaratory relief.

These common questions of law and fact also predominate over any questions

affecting only individual members.

48.

Plaintiffs Brewster and Wheelers claims are typical of the claims of other

members of the Class because the FCRA violation suffered by Plaintiffs Wheeler and
Brewster are typical of that suffered by other Class members and Defendant treated Plaintiffs
Wheeler and Brewster consistent with other Class members in accordance with its standard
policies and procedures.
49.

Plaintiffs Wheeler and Brewster are able to fairly and adequately represent the

50.

The Class Counsel, Thomas & Solomon LLP, is qualified and able to litigate

51.

The Class Counsel concentrates its practice in employment litigation, and its

52.

This class action is also maintainable under subsection (3) of Rule 23(b)

interests of the Class and have no interest antagonistic to the Class.

the Plaintiff and Class Members claims.

attorneys are experienced in class action litigation.

because questions of law or fact common to class members (see supra 46) predominate over
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Case 6:16-cv-06825-FPG Document 1 Filed 12/17/16 Page 9 of 11

any questions affecting only individual members, and a class action is superior to other
available methods for fairly and efficiently adjudicating this controversy
53.

Alternatively, the questions of law and fact common to the class may be

certified for class action treatment separately from any questions affecting only individual

members under Rule 23(c)(4) because resolution of those common questions will
significantly advance the litigation.

CAUSE OF ACTION
Defendant Violated the FCRA by Causing Consumer Reports to be Procured Without First
Making a Proper Disclosure
15 U.S.C. 1681b(b)(2)(A)(i)
54.

Plaintiffs Wheeler and Brewster hereby re-allege and incorporate the

55.

Defendant has violated the FCRA by procuring or causing consumer reports to

allegations set forth above.

be procured on Plaintiffs Wheeler, Brewster and other Class members without making the
required disclosure. See 15 U.S.C. 1681b(b)(2)(A)(i).
56.

Defendant acted willfully and in deliberate or reckless disregard of its

57.

Defendants willful conduct is reflected by the above paragraphs as well as the

obligations and the rights of Plaintiffs Wheeler, Brewster, and other Class members.
following:

a.
b.

c.

Wegmans was founded before the FCRA was enacted and it has
therefore had more than 40 years to become compliant;

Defendants conduct is inconsistent with the Federal Trade

Commissions longstanding regulatory guidance, judicial interpretation,
and the plain language of the statute; see Exhibit A; Reardon, 2013 WL
6231606, Singleton, 2012 WL 245965; and
Despite the plain statutory text and there being a depth of guidance,
Defendant adopted a policy of having consumer reports procured on its
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Case 6:16-cv-06825-FPG Document 1 Filed 12/17/16 Page 10 of 11

58.

employees and job applicants without properly disclosing to them that

the reports will be procured on them.

Plaintiffs Wheeler, Brewster, and Class members are entitled to statutory

damages of not less than $100 and not more than $1,000 for each and every one of these
violations, pursuant to 15 U.S.C. 1681n(a)(1)(A).
59.

Plaintiffs Wheeler, Brewster, and Class members are entitled to punitive

damages of not less than $100 and not more than $1,000 for each and every one of these
violations, pursuant to 15 U.S.C. 1681n(a)(2).
60.

Plaintiffs Wheeler, Brewster, and Class members are further entitled to recover

their costs and attorneys fees, pursuant to 15 U.S.C. 1681n(a)(3).

WHEREFORE, Plaintiffs Wheeler and Brewster, on behalf of themselves and the

Class, pray for relief as follows:

(a)

(b)
(c)

(d)
(e)
(f)

(g)
(h)
(i)
(j)

Determining that this action may proceed as a class action under Rule 23 of
the Federal Rules of Civil Procedure;
Designating Wheeler and Brewster as class representatives;

Awarding class representatives Wheeler and Brewster service payments;

Designating Thomas & Solomon LLP as Plaintiffs and Class members

counsel;
Declaring that Defendant violated the FCRA;

Issuing proper notice of the class at Defendants expense;

Declaring that Defendant acted willfully in deliberate or reckless disregard of

Plaintiffs rights and its obligations under the FCRA;
Awarding statutory damages and punitive damages as provided by the FCRA;
Awarding reasonable attorneys fees and costs as provided by the FCRA; and

Such other and further legal or equitable relief as this Court deems to be just
and appropriate.
- 10 -

Case 6:16-cv-06825-FPG Document 1 Filed 12/17/16 Page 11 of 11

JURY
IURY DEMAND

factininaccordance
with
Plaintiffs
demand aa iury
jury to hear
hear and
decideall
allissues
issues of
of fact
accordance with
Plaintiffs demand
anddecide

Federal Rule of Civil

Civil Procedure
Procedure 3B(b).
38(b).
Dated: December 16, 2016
2OL6
MAS St. SOLOMON LLP
By:
elson Thomas, Esq.
Michael J. Lingle, Esq.
Jessica
Lukasiewicz, Esq.
|essica L. Lukasiewicz,
AuorneysJor
Attorneys for Plaintffi
Plaintiffs
693 East
East Avenue
Rochester, New York 14607
14607
(585) 272-0540
Telephone: (585)
272-0540
nthomas@theemploymentattorneys.com
nthomas @ theemploymentattomeys. com
mlingle@theemploymentattorneys.com
miin gle @theemploymentattomeys.com
jlukasiewicz@theemploymentattorneys.com
lukasiewicz@theemploymentattorneys. com
j

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Case 6:16-cv-06825-FPG Document 1-1 Filed 12/17/16 Page 1 of 4

Exhibit A

Advisory OpinionDocument
to Hawcwell (06-12-93)
Federal12/17/16
Trade Commission
Case 6:16-cv-06825-FPG
1-1 1Filed
Page 2 of 4

1/22/2016

FEDERAL TRADE COMMISSION

PROTECTING AMERICA'S CONSUMERS

Mir

//////////////////////

Advisory Opinion to Hauxwell (06-12-98)

June 12, 1998
Richard W. Hauxwell, CEO
Accufax Div., Southwest
P.O. Box 35563
Tulsa, OK 74153-0563
Dear Mr. Hauxwell:

Re: Sections 604 and 606 of the Fair Credit Reporting Act
This is in response to your letter asking for clarification of sections 604 and 606 of the Fair Credit Reporting Act
("FCRA"). You note that your company is a consumer reporting agency and that you are asking these questions
on behalf of your clients. Your questions are addressed below in the order in which you presented them.
1. Is it safe for us to assume, based on your opinion letter to Mr. Richard Steer, that we can combine the
disclosure and release form, which includes applicant identifiers, in one form such as the enclosed
sample?
Section 604(b) of the FCRA requires any employer who intends to obtain a consumer report for employment
purposes to disclose this to the applicant or employee (in a document that consists solely of the disclosure) and
to obtain the applicant or employee's written permission. As noted in the letter you cited (Steer, 10/21/97), it is
our position that the disclosure notice and the authorization may be combined. If they are combined, identifying
information (such as date of birth, Social Security number, drivers license number, and current and former
addresses) may be included in the form. However, the form should not contain any extraneous information.
While we believe that you may combine the disclosure and authorization (and include identifying information) as
you have in the draft form that you included with your letter, we note that your draft disclosure includes a waiver
by the consumer of his or her rights under the FCRA. The inclusion of such a waiver in a disclosure form will
violate Section 604(b)(2)(A) of the FCRA, which requires that a disclosure consist "solely" of the disclosure that
a consumer report may be obtained for employment purposes. Moreover, it is a general principle of law that
benefits provided to citizens by federal statute generally may not be waived by private agreement unless
Congress intended such a result. Brooklyn Savings Bank v. O'Neill, 324 U.S. 697 (1945). We note that no
authorization for a waiver is contained in the FCRA; nor does the legislative history show that Congress intended
that consumers should be able to sign away their legal rights under the Act a) Accordingly, employers and other
users of information covered by the FCRA may not require consumers to waive their rights under the law.
2. Our members would also like futher clarification with regard to Section 606 as to when a Summary of
Rights should be provided to the applicant The language of the law is confusing.
https://ww.v.flc.govIpolicy/advisory-ociricrs/advisory-ociricii-hauxwell-06-12-98

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Advisory OpinionDocument
to Hauxwell (06-12-98)
Federal12/17/16
Trade Commission
Case 6:16-cv-06825-FPG
1-1 1Filed
Page 3 of 4

Section 606 of the FCRA mandates that specific procedures be followed when an investi-gative consumer report
is requested by an employer or other user who has a permissible purpose to obtain the report. First, Section
606(a)(1)(A) requires any person procuring an investigative consumer report to disclose this fact to the affected
consumer not later than three days after the date on which the report was first requested. Second, Section
606(a)(1)(B) requires that the dis-closure include a statement of the consumer's right to obtain additional
information and a copy of the summary of consumer rights prescribed by the Commission. Finally, Section
606(b) sets out the information that must be disclosed when the consumer requests a disclosure pursuant to
Section 606(a)(1)(B).
The issue that you raise concerns exactly at what point the Commission's summary of rights must be sent. The
language of Section 606(a)(1)(B) is not entirely clear in mandating that the disclosure "includes a statement
informing the consumer of his right to request the additional disclosures provided for under subsection (b) of this
section [the nature and scope of the inves-tigation] and the written summary of the rights of the consumer
prepared pursuant to section 609(c)." As you can see, the reference to the summary of rights comes after a
reference to sub-part 606(b), but in a general discussion of the content of the sub-part 606(a)(1)(A) notice.
There are two possible interpretations of this ambiguous language: (1) that Congress in-tended for the summary
to be sent with the initial Section 606(a)(1)(A) notice (that an investiga-tive consumer report has been or may be
procured); or (2) that Congress intended that the sum-mary be provided with the subsequent Section 606(b)
disclosure of the "nature and scope" of the investigation. The Commission's "Notice to Users of Consumer
Reports: Obligations of Users Under the FCRA,"() states that the summary of rights should be provided with the
Section 606(a) notice that an investigative consumer report has been or may be obtained. However, because the
statutory language may be interpreted to require that the summary be sent with the subsequent Section 606(b)
disclosure, it is unlikely that the Commission's staff would recommend any en-forcement action if the notice is
sent with the Section 606(b) notice instead of the Section 606(a) notice.
3. We would like your opinion regarding end-user organizations which procure criminal and other public
record information for employment purposes directly from a federal, state, or county record repository.
Would the government repository (agency) providing the information directly to the end-user
organization ... requesting the information be considered a consumer reporting agency and subject to
the same laws as a privately held consumer reporting agency?
In general, information that is obtained by an employer directly from a federal, state or county record repository
is not a "consumer report" because the repository (such as a courthouse or a state law enforcement agency) is
not normally a "consumer reporting agency" and is itself not covered by the FCRA. The attached staff letters
(Copple, 6/10/98; Goeke, 6/9/98) discuss this issue in more detail. Therefore, an employer who obtains
information directly from a public record source is not subject to the FCRA as to that information. However,
because of the fact that information in public record sources may be inaccurate or incomplete, we believe that
em-ployers who use this type of information should voluntarily disclose to consumers the nature and substance
of any public record information that they rely upon in taking any adverse action. If the information is, in fact,
inaccurate or incomplete, the consumer may then take steps to correct the problem.
I hope that this information is helpful to you. The views that are expressed above are those of the Commission's
staff and not the views of the Commission itself.
Sincerely,
William Haynes
Attorney
Division of Credit Practices
https://www.ftc.gov/pol icy/advisory-opi nions/advisory-opi nion-hauxwell-06-12-98

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Advisory OpinionDocument
to HaLanvell (06-12-98)1
Federal 12/17/16
Trade Commission
Case 6:16-cv-06825-FPG
1-1 Filed
Page 4 of 4

1. The FCRA is part of the Consumer Credit Protection Act, 15 U.S.C. 1601. We note that the Truth In Lending
Act, which is Subchapter I of the Consumer Credit Protection Act, does permit consumers to waive certain
rights.
2. The Commission's notice may be found at 16 C.F.R. 601, Appendix C (1997).

ftc.g ov

htlps://www.fir.govfpollcyladvlsory-opinlonsiadvlsory-opinlon-hauxwell-06- 12-98

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Case 6:16-cv-06825-FPG Document 1-2 Filed 12/17/16 Page 1 of 2

SHEET
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Brewster, Jerah,
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CAUSE OF.{CTION
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ANy
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DATE
DATE

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CHECK YES
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DEMAND $
DEMANDS

Yes 0llNo
No
JURY
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JURY DEN{AND:
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Case 6:16-cv-06825-FPG Document 1-2 Filed 12/17/16 Page 2 of 2

Attachment

Part 1(c) - Attorneys for Plaintiffs

J. Nelson Thomas
Thomas & Solomon LLP
693 East Avenue
Rochester, NY 14607
(585) 272-0540
Michael J. Lingle
Thomas & Solomon LLP
693 East Avenue
Rochester, NY 14607
(585) 272-0540
Jessica L. Lukasiewicz
Thomas & Solomon LLP
693 East Avenue
Rochester, NY 14607
(585) 272-0540

Case 6:16-cv-06825-FPG Document 1-3 Filed 12/17/16 Page 1 of 2

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

UNITED STATES DISTRICT COURT

for the

Western District
York
__________
DistrictofofNew
__________

ASHLEIGH WHEELER AND JERAH BREWSTER,

Plaintiff(s)

v.

WEGMANS FOOD MARKETS, INC.,

Defendant(s)

)
)
)
)
)
)
)
)
)
)
)
)

Civil Action No. 16-cv-06825

SUMMONS IN A CIVIL ACTION

To: (Defendants name and address)
Wegmans Food Markets, Inc.
1500 Brooks Avenue
Rochester, NY 14603-0844

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 plaintiffs attorney,
whose name and address are:
Thomas & Solomon LLP
693 East Avenue
Rochester, NY 14607

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

Case 6:16-cv-06825-FPG Document 1-3 Filed 12/17/16 Page 2 of 2

AO 440 (Rev. 06/12) Summons in a Civil Action (Page 2)

Civil Action No. 16-cv-06825

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 individuals 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 individuals 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:
Servers signature

Printed name and title

Servers address

Additional information regarding attempted service, etc:

0.00