On November 30, 2017 a
Proof of Service
was filed
involving a dispute between
Danbury Hospital,
and
Matthew Jenkins,
for S05 - Small Claims - Small Claims - Collection - Hospital
in the District Court of Fairfield County.
Preview
STATEMENT OF SERVICE — (DELIVERY)
SMALL CLAIMS
JD-CV-123 New 1-11
1)
2)
3.)
Instructions
Fill out 1 form for each defendant. Attach all documents that show how the Small Claims Writ and
Notice of Suit and related documents were served on (delivered to) the defendant, and check the box
below that applies. Keep all receipts that show how much you paid to have the Small Claims Writ and
Notice of Suit and related documents served on (delivered to) the defendant.
For service on (delivery to) the Perens +. | Sen .
(Write name of Defendant)
The attached Small Claims Writ and Notice of Suit with related documents, if any, were served on
(delivered to) the defendant named above by:
(Check the box that applies)
X] priority mail with delivery confirmation; delivery confirmation is attached. I paid $ 5.75 for this, or
certified mail, return receipt requested; signed return receipt Is attached. | paid $ for this, or
a nationally recognized courier service providing delivery confirmation; tracking information showing delivery
is attached. | paid $ for this, or
4.) [a proper officer in the manner in which a writ of summons is served in a civil action; officer's return of service
filed with the court.
Signature of Plaintiff or Plaintiff's Representative
(Check one)
O Plaintiff x] Plaintiffs representative
Type or print name of signer Date
Robert L. Peat | )- lb-2O 7
The Judicial Branch of the State of Connecticut complies with the Americans with Disabilities Act
(ADA). If you need a reasonable accommodation in accordance with the ADA, contact a court
clerk or an ADA contact person listed at www.jud.ct.gow/ADA/.USPS Transaction Details Page 1 of 1
Return Address: Robert L Peat Print Date: November 09, 2017 - 09:39:12 AM
Flanagan & Peat Mail Date: November 09, 2017
57 North Street User: Flanaganpeat
Suite 102 Weight: 1 lbs 0 oz
Danbury, CT 06810 Refund Type: —E-refund
Delivery Address: Matthew Jenkins Printed Msg:
48 Twin Oaks Lane
Danbury, CT 06811-3386
Cost Code:
Class/Service: Priority Mail ® $5.75
Special Services: USPS Tracking
Insurance: N/A
TOTAL COST: $5.75
Tracking: 9405511298370878262328
7 Local eee =
Location Date Time Description FE i
rT ~ ' 4
DANBURY, CT, 06811 November 10, 11:30:00 Delivered, In/At Mailbox a
DANBURY, CT, 06811 November 10, 49:00:00 Out for Delivery
DANBURY, CT, 06811 november 19, 99:50:00 Sorting Complete as
https://or.stamps.com/PostageTools/USPSInfoBox.aspx?postage_id=6174245822&un=15... 11/16/2017
Document Filed Date
November 30, 2017
Case Filing Date
November 30, 2017
Category
S05 - Small Claims - Small Claims - Collection - Hospital
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Preview
STATEMENT OF SERVICE — (DELIVERY) SMALL CLAIMS JD-CV-123 New 1-11 1) 2) 3.) Instructions Fill out 1 form for each defendant. Attach all documents that show how the Small Claims Writ and Notice of Suit and related documents were served on (delivered to) the defendant, and check the box below that applies. Keep all receipts that show how much you paid to have the Small Claims Writ and Notice of Suit and related documents served on (delivered to) the defendant. For service on (delivery to) the Perens +. | Sen . (Write name of Defendant) The attached Small Claims Writ and Notice of Suit with related documents, if any, were served on (delivered to) the defendant named above by: (Check the box that applies) X] priority mail with delivery confirmation; delivery confirmation is attached. I paid $ 5.75 for this, or certified mail, return receipt requested; signed return receipt Is attached. | paid $ for this, or a nationally recognized courier service providing delivery confirmation; tracking information showing delivery is attached. | paid $ for this, or 4.) [a proper officer in the manner in which a writ of summons is served in a civil action; officer's return of service filed with the court. Signature of Plaintiff or Plaintiff's Representative (Check one) O Plaintiff x] Plaintiffs representative Type or print name of signer Date Robert L. Peat | )- lb-2O 7 The Judicial Branch of the State of Connecticut complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation in accordance with the ADA, contact a court clerk or an ADA contact person listed at www.jud.ct.gow/ADA/.USPS Transaction Details Page 1 of 1 Return Address: Robert L Peat Print Date: November 09, 2017 - 09:39:12 AM Flanagan & Peat Mail Date: November 09, 2017 57 North Street User: Flanaganpeat Suite 102 Weight: 1 lbs 0 oz Danbury, CT 06810 Refund Type: —E-refund Delivery Address: Matthew Jenkins Printed Msg: 48 Twin Oaks Lane Danbury, CT 06811-3386 Cost Code: Class/Service: Priority Mail ® $5.75 Special Services: USPS Tracking Insurance: N/A TOTAL COST: $5.75 Tracking: 9405511298370878262328 7 Local eee = Location Date Time Description FE i rT ~ ' 4 DANBURY, CT, 06811 November 10, 11:30:00 Delivered, In/At Mailbox a DANBURY, CT, 06811 November 10, 49:00:00 Out for Delivery DANBURY, CT, 06811 november 19, 99:50:00 Sorting Complete as https://or.stamps.com/PostageTools/USPSInfoBox.aspx?postage_id=6174245822&un=15... 11/16/2017