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STATEMENT OF SERVICE — (DELIVERY)
SMALL CLAIMS :
JD-CV-123 New 1-11
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 eT - . : - > r)\ a,
” (White name of Defend:
‘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)
1.) [XJ priority mail with delivery confirmation; delivery confirmation is attached. | paid $ > : £ 2 )_ for this, or
2.) [certified mail, return receipt requested; signed retum receipt is attached. | paid $ for this, or
3.) [a nationally recognized courier service providing delivery confirmation; tracking information showing delivery ©
is attached. | paid $ for this, or
4) [1 aproper officer in the manner in which a writ of summons is served in a civil action; officer's retum of service
filed with the court.
So
Signature of Plaintiff or Plaintiffs Representative
(Check one)
(1 Plaintiff Plaintiffs representative
Type or print name of signer Date,
Holly Nelen, Esq. > 3 .
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/ADAV.Endicia Account - Reports - Tjgmgactions - Detail e@ Page 1 of 2
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Account Summary Update Profile ¥ Software ¥ Tools ¥ Reports ¥ Help
Track your
Package Status
Details Notifications
Ship To [From Welght: 3 Oz.
Mail Class: Priority Mail Critical Mail Letter
DOROTHY BROWN Donna Porter Delivery Confirmation
89 BIRDSEY ST 510 TOLLAND ST Postage: $3.50
BRIDGEPORT, CT 06610-2508 EAST HARTFORD, CT 06108- Declared Value $0.00
2501 Package ID: 9476015969005804393785
Bafana Request Status:
Estimated Date: N/A
Form ID: N/A
Summary Status
Printed on: 05/15/14 - 2:42:52 PM
Postmarked: 05/15/14 Reference ID: Y03449
Group Code: 0 Description: 03449
(860)528-9991
Your item was delivered at 12:00 pm on May 19, 2014 in BRIDGEPORT, CT 06610.
Detailed Results
Your item was delivered at 12:00 pm on May 19. 2014 in BRIDGEPORT, CT 06610.
Out for Delivery, May 19, 2014, 9:07 am, BRIDGEPORT, CT 06610
Sorting Complete. May 19, 2014, 8:57 am, BRIDGEPORT, CT 06610
Arrival at Post Office, May 19, 2014, 8:11 am, BRIDGEPORT, CT 06610
Depart USPS Sort Facility, May 19, 2014, 5:51 am, STAMFORD, CT 06910
Processed through USPS Sort Facility, May 18, 2014, 11:08 pm, STAMFORD, CT 06910
Processed through USPS Sort Facility, May 18, 2014, 3:14 pm, WHITE PLAINS, NY 10610
Depart USPS Sort Facility, May 17, 2014, 6:08 am, HARTFORD, CT 06101
Processed at USPS Origin Sort Facility, May 16, 2014, 9:57 pm, HARTFORD, CT 06101
Accepted at USPS Origin Sort Facility, May 16. 2014, 8:42 pm, EAST HARTFORD, CT 06108 t
Electronic Shipping Info Received, May 15, 2014 {
on — J
View USPS Details
Refer a Friend
Become an Affiliate
Get a coupon for $25 offat the — Eam cash for referrals
https://www.endicia.com/Account/Reports/Transactions/Detail/default.cfm?TrackingNum... 5/22/2014
Preview
ms * > 6 STATEMENT OF SERVICE — (DELIVERY) SMALL CLAIMS : JD-CV-123 New 1-11 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 eT - . : - > r)\ a, ” (White name of Defend: ‘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) 1.) [XJ priority mail with delivery confirmation; delivery confirmation is attached. | paid $ > : £ 2 )_ for this, or 2.) [certified mail, return receipt requested; signed retum receipt is attached. | paid $ for this, or 3.) [a nationally recognized courier service providing delivery confirmation; tracking information showing delivery © is attached. | paid $ for this, or 4) [1 aproper officer in the manner in which a writ of summons is served in a civil action; officer's retum of service filed with the court. So Signature of Plaintiff or Plaintiffs Representative (Check one) (1 Plaintiff Plaintiffs representative Type or print name of signer Date, Holly Nelen, Esq. > 3 . 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/ADAV.Endicia Account - Reports - Tjgmgactions - Detail e@ Page 1 of 2 (800) 676-3279 | siGnout | 0) | © Home Products Store Partners Developers Support My Account Account Summary Update Profile ¥ Software ¥ Tools ¥ Reports ¥ Help Track your Package Status Details Notifications Ship To [From Welght: 3 Oz. Mail Class: Priority Mail Critical Mail Letter DOROTHY BROWN Donna Porter Delivery Confirmation 89 BIRDSEY ST 510 TOLLAND ST Postage: $3.50 BRIDGEPORT, CT 06610-2508 EAST HARTFORD, CT 06108- Declared Value $0.00 2501 Package ID: 9476015969005804393785 Bafana Request Status: Estimated Date: N/A Form ID: N/A Summary Status Printed on: 05/15/14 - 2:42:52 PM Postmarked: 05/15/14 Reference ID: Y03449 Group Code: 0 Description: 03449 (860)528-9991 Your item was delivered at 12:00 pm on May 19, 2014 in BRIDGEPORT, CT 06610. Detailed Results Your item was delivered at 12:00 pm on May 19. 2014 in BRIDGEPORT, CT 06610. Out for Delivery, May 19, 2014, 9:07 am, BRIDGEPORT, CT 06610 Sorting Complete. May 19, 2014, 8:57 am, BRIDGEPORT, CT 06610 Arrival at Post Office, May 19, 2014, 8:11 am, BRIDGEPORT, CT 06610 Depart USPS Sort Facility, May 19, 2014, 5:51 am, STAMFORD, CT 06910 Processed through USPS Sort Facility, May 18, 2014, 11:08 pm, STAMFORD, CT 06910 Processed through USPS Sort Facility, May 18, 2014, 3:14 pm, WHITE PLAINS, NY 10610 Depart USPS Sort Facility, May 17, 2014, 6:08 am, HARTFORD, CT 06101 Processed at USPS Origin Sort Facility, May 16, 2014, 9:57 pm, HARTFORD, CT 06101 Accepted at USPS Origin Sort Facility, May 16. 2014, 8:42 pm, EAST HARTFORD, CT 06108 t Electronic Shipping Info Received, May 15, 2014 { on — J View USPS Details Refer a Friend Become an Affiliate Get a coupon for $25 offat the — Eam cash for referrals https://www.endicia.com/Account/Reports/Transactions/Detail/default.cfm?TrackingNum... 5/22/2014