Moore v. East Georgia Regional Medical Center et al

Filing 5

ORDER Directing Service re 1 Complaint filed by Stephanie D Moore. Signed by Magistrate Judge G. R. Smith on 11/17/17. (Attachments: # 1 USM 285) (jrb)

USM-285 is a 5-part form. Fill out the form and print 5 copies. Sign as needed and route as specified below.
U.S. Department of Justice
United States Marshals Service

PROCESS RECEIPT AND RETURN

PLAINTIFF

COURT CASE NUMBER

Stephanie D. Moore

6:17cv-115

DEFENDANT

TYPE OF PROCESS

East Georgia Regional Medical Center

Order/Complaint

NAME OF INDIVIDUAL, COMPANY, CORPORATION. ETC. TO SERVE OR DESCRIPTION OF PROPERTY TO SEIZE OR CONDEMN

{

SERVE
AT

East Georgia Medical Center
ADDRESS (Street or RFD, Apartment No., City, State and ZIP Code)

1499 Fair Road, Statesboro, GA 30459

SEND NOTICE OF SERVICE COPY TO REQUESTER AT NAME AND ADDRESS BELOW

2

Number of parties to be
served in this case

Stephanie D Moore
623 Clarkplace Road
Waynesboro, GA 30830

Number of process to be
served with this Form 285

1

Check for service
on U.S.A.
SPECIAL INSTRUCTIONS OR OTHER INFORMATION THAT WILL ASSIST IN EXPEDITING SERVICE (Include Business and Alternate Addresses,
All Telephone Numbers, and Estimated Times Available for Service):
Fold

Fold

BY ORDER OF THE COURT

Signature of Attorney other Originator requesting service on behalf of:

Scott L. Poff, Clerk

$

PLAINTIFF
DEFENDANT

TELEPHONE NUMBER

DATE

912-650-4032

11/17/17

SPACE BELOW FOR USE OF U.S. MARSHAL ONLY-- DO NOT WRITE BELOW THIS LINE
I acknowledge receipt for the total
number of process indicated.
(Sign only for USM 285 if more
than one USM 285 is submitted)

Total Process

District of
Origin

District to
Serve

No.

No.

Signature of Authorized USMS Deputy or Clerk

Date

I hereby certify and return that I
have personally served ,
have legal evidence of service,
have executed as shown in "Remarks", the process described
on the individual , company, corporation, etc., at the address shown above on the on the individual , company, corporation, etc. shown at the address inserted below.
I hereby certify and return that I am unable to locate the individual, company, corporation, etc. named above (See remarks below)
Name and title of individual served (if not shown above)

A person of suitable age and discretion
then residing in defendant's usual place
of abode

Address (complete only different than shown above)

Date

Time

am
pm

Signature of U.S. Marshal or Deputy

Service Fee

Total Mileage Charges Forwarding Fee
including endeavors)

Total Charges

Advance Deposits

Amount owed to U.S. Marshal* or
(Amount of Refund*)

REMARKS:

PRINT 5 COPIES: 1. CLERK OF THE COURT
2. USMS RECORD
3. NOTICE OF SERVICE
4. BILLING STATEMENT*: To be returned to the U.S. Marshal with payment,
if any amount is owed. Please remit promptly payable to U.S. Marshal.
5. ACKNOWLEDGMENT OF RECEIPT

PRIOR EDITIONS MAY BE USED
Form USM-285
Rev. 12/15/80
Automated 01/00

INSTRUCTIONS FOR SERVICE OF PROCESS BY U.S. MARSHAL
Please type or print legibly, insuring readability of all copies. DO NOT DETACH ANY
COPIES. Submit one complete set of this form (USM-285) and one copy of each writ for each
individual, company, corporation, etc., to be served or property to be seized or condemned. The
applicable fees for such service(s) (T28, USC Sec. 1921 establishes the fees for service of
process by the U.S. Marshal) may be required prior to said service.
For service of any process upon an officer or agent of the United States Government, submit a
copy of the writ and a set of Form USM-285 for each officer or agent upon whom service is
desired. Submit three (3) additional copies of the writs for service upon the Government of the
United States. The U.S. Marshal will serve one (1) upon the U.S. Attorney and will forward two
(2) to the Attorney General of the United States. (When the applicable box is checked,
completion of the final signature block by the U.S. Marshal or his Deputy always certifies service
on the U.S. Attorney and the Attorney General, regardless of whether other defendants on the
writ were served.) Failure to provide any of the copies will delay service of the writ.
Complete all entries above the double line. Mark all applicable check boxes and use the ''Special
Instructions'' to advise of any information that will assist the U.S. Marshal in expediting service.
It more than one writ and USM-285 is submitted on a single case, the U.S. Marshal will receipt
for all of them on the first USM-285. You will receive for your records the last (No. 5)
"Acknowledgment of Receipt" copy for all the USM-285 forms you submit. When the writ is
served, you will receive the No. 3 Notice of Service copy. This copy will be identical to the
return to the Clerk of the Court.
Upon completion of all services (if the Marshals fees were not requested or tendered in advance
or if additional fees are indicated), you will receive a ''Billing Statement'' (copy 4 of USM-285)
from the United States Marshal. (NOTE: Copy 4 should be returned, by you, to the U.S. Marshal,
together with your payment of the amount owed.
Additional supplies of the USM-285 may be obtained from the Clerk of the U.S. District Court
or U.S. Marshal, without cost.