AO 398 (1/09) Notice oI a Lawsuit and Request to Waive Service oI a Summons

UNITED STATES DISTRICT COURT

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PIaintiII
v. CiviI Action No.
DeIendant
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To:
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A Iawsuit has been IiIed against vou, or the entitv vou represent, in this court under the number shown above.
A copv oI the compIaint is attached.
This is not a summons, or an oIIiciaI notice Irom the court. It is a request that, to avoid expenses, vou waive IormaI
service oI a summons bv signing and returning the encIosed waiver. To avoid these expenses, vou must return the signed
waiver within davs ( 02>. +< 4.+;< &% -+?; 79 +< 4.+;< '% -+?; 2/ <1. -./.6-+6< 2; 7=<;2-. +6? 3=-2,2+4 -2;<92,< 7/ <1.
*62<.- )<+<.; ) Irom the date shown beIow, which is the date this notice was sent. Two copies oI the waiver Iorm are
encIosed, aIong with a stamped, seII-addressed enveIope or other prepaid means Ior returning one copv. You mav keep the
other copv.
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II vou return the signed waiver, I wiII IiIe it with the court. The action wiII then proceed as iI vou had been served
on the date the waiver is IiIed, but no summons wiII be served on vou and vou wiII have 60 davs Irom the date this notice
is sent (see the date beIow) to answer the compIaint (or 90 davs iI this notice is sent to vou outside anv iudiciaI district oI
the United States).
II vou do not return the signed waiver within the time indicated, I wiII arrange to have the summons and compIaint
served on vou and vou, or the entitv vou represent, mav be required to pav the expenses oI making service.
PIease read the encIosed statement about the dutv to avoid unnecessarv expenses.
I certiIv that this request is being sent to vou on the date beIow.
Date
Signature oI the attornev or unrepresented partv
Printed name
Address
E-maiI address
TeIephone number
DISTRICT OF NEW HAMPSHIRE
DARTMOUTH-HITCHCOCK CLINIC AND MARY HITCHCOCK
MEMORIAL HOSPITAL D/B/A DARTMOUTH-HITCHCOCK, et al.
NICHOLAS A. TOUMPAS, in his official capacity as Commissioner of the NH
Depart. of Health and Human Services
NICHOLAS A. TOUMPAS, in his official capacity as Commissioner of the NH Depart. of Health and Human Services
30
July 25, 2011 /s/ W. Scott O'Connell
W. Scott O'Connell, Esquire
Nixon Peabody LLP, 900 Elm Street, Manchester, NH 03101
soconnell@nixonpeabody.com
(603) 628-4000
Case 1:11-cv-00358 Document 1-2 Filed 07/25/11 Page 1 of 2
AO 399 (1/09) Waiver oI the Service oI Summons
UNITED STATES DISTRICT COURT
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)
)
)
)
PIaintiII
v. CiviI Action No.
DeIendant
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To:
!(+5. 7/ <1. 84+26<2//A; +<<796.? 79 =69.89.;.6<.- 84+26<2//)
I have received vour request to waive service oI a summons in this action aIong with a copv oI the compIaint,
two copies oI this waiver Iorm, and a prepaid means oI returning one signed copv oI the Iorm to vou.
I, or the entitv I represent, agree to save the expense oI serving a summons and compIaint in this case.
I understand that I, or the entitv I represent, wiII keep aII deIenses or obiections to the Iawsuit, the court`s
iurisdiction, and the venue oI the action, but that I waive anv obiections to the absence oI a summons or oI service.
I aIso understand that I, or the entitv I represent, must IiIe and serve an answer or a motion under RuIe 12 within
60 davs Irom , the date when this request was sent (or 90 davs iI it was sent outside the
United States). II I IaiI to do so, a deIauIt iudgment wiII be entered against me or the entitv I represent.
Date
Signature oI the attornev or unrepresented partv
Printed name
Address
E-maiI address
TeIephone number
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RuIe 4 oI the FederaI RuIes oI CiviI Procedure requires certain deIendants to cooperate in saving unnecessarv expenses oI serving a summons
and compIaint. A deIendant who is Iocated in the United States and who IaiIs to return a signed waiver oI service requested bv a pIaintiII Iocated in
the United States wiII be required to pav the expenses oI service, unIess the deIendant shows good cause Ior the IaiIure.
+#((&"%$*)',"&(') 67< incIude a beIieI that the Iawsuit is groundIess, or that it has been brought in an improper venue, or that the court has
no iurisdiction over this matter or over the deIendant or the deIendant`s propertv.
II the waiver is signed and returned, vou can stiII make these and aII other deIenses and obiections, but vou cannot obiect to the absence oI
a summons or oI service.
II vou waive service, then vou must, within the time speciIied on the waiver Iorm, serve an answer or a motion under RuIe 12 on the pIaintiII
and IiIe a copv with the court. Bv signing and returning the waiver Iorm, vou are aIIowed more time to respond than iI a summons had been served.
DISTRICT OF NEW HAMPSHIRE
DARTMOUTH-HITCHCOCK CLINIC AND MARY HITCHCOCK
MEMORIAL HOSPITAL D/B/A DARTMOUTH-HITCHCOCK, et al.
NICHOLAS A. TOUMPAS, in his official capacity as Commissioner of the
NH Depart. of Health and Human Services
W. Scott O'Connell, Esquire
Case 1:11-cv-00358 Document 1-2 Filed 07/25/11 Page 2 of 2