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1 IN THE UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF OHIO EASTERN DIVISION MATTHEW DAVID KELLY : CASE NO: 2:14-cv-307 144 Flintstone Drive Harrison, Ohio 45030 : Plaintiff : -vs- : CLINTON E. SINES : COMPLAINT AND JURY DEMAND Fayette County Deputy Sheriff in his individual capacity : c/o Vernon P. Stanforth : Fayette County Sheriff 113 East Market Street : Washington Court House, Ohio 43160 : and : VERNON P. STANFORTH Fayette County Sheriff : in his official capacity 113 East Market Street : Washington Court House, Ohio 43160 : and : BRYAN COOK Ohio State Trooper : in his individual capacity : c/o Ohio State Highway Patrol Wilmington Patrol Post : 950 Rombach Avenue Wilmington, Ohio 45177 : Defendants : PARTIES For his complaint against Defendants Clinton E. Sines, Vernon P. Stanforth, and Bryan Case: 2:14-cv-00307-GLF-NMK Doc #: 1 Filed: 04/02/14 Page: 1 of 8 PAGEID #: 1

Matthew David Kelly v. Clinton Sines, et. al

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"A Hamilton County man has filed a federal lawsuit against the Fayette County sheriff and a deputy, and a State Highway Patrol trooper, alleging excessive use of force after he was shot in the eye with a Taser." - Columbus Dispatch, May 10, 2014

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Page 1: Matthew David Kelly v. Clinton Sines, et. al

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IN THE UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF OHIO

EASTERN DIVISION

MATTHEW DAVID KELLY : CASE NO: 2:14-cv-307

144 Flintstone Drive

Harrison, Ohio 45030 :

Plaintiff :

-vs- :

CLINTON E. SINES : COMPLAINT AND JURY DEMAND

Fayette County Deputy Sheriff

in his individual capacity :

c/o Vernon P. Stanforth :

Fayette County Sheriff

113 East Market Street :

Washington Court House, Ohio 43160

:

and

:

VERNON P. STANFORTH

Fayette County Sheriff :

in his official capacity

113 East Market Street :

Washington Court House, Ohio 43160

:

and

:

BRYAN COOK

Ohio State Trooper :

in his individual capacity

:

c/o Ohio State Highway Patrol

Wilmington Patrol Post :

950 Rombach Avenue

Wilmington, Ohio 45177 :

Defendants :

PARTIES

For his complaint against Defendants Clinton E. Sines, Vernon P. Stanforth, and Bryan

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Cook, Plaintiff Matthew D. Kelly states as follows:

1. Plaintiff Matthew D. Kelly is a natural person who resides in the City of Harrison,

Hamilton County, Ohio.

2. Defendant Clinton E. Sines is a natural person who resides in Washington Court

House, Fayette County, Ohio. At all relevant times, Sines was employed as a deputy sheriff by

the Fayette County Sheriff’s Office and was acting under color of state law.

3. Defendant Vernon P. Stanforth is and at all relevant times was the Sheriff of

Fayette County, Ohio and employed Defendant Clinton E. Sines as an assistant deputy sheriff.

4. Defendant Bryan Cook is a natural person who at all relevant times was employed

as a patrol officer by the Ohio Highway Patrol and was acting under color of state law.

JURISDICTION AND VENUE

5. This action is brought under 42 U.S.C. § 1983 to redress injuries to Mr. Kelly

caused by Defendant Sines’s use of excessive force against Mr. Kelly and Defendant Cook’s

failure to intervene to stop Sines’s use of excessive force. This court has jurisdiction of this

cause under 42 U.S.C. § 1983 and 28 U.S.C. § 1331. This court has supplemental jurisdiction of

the state law claims pursuant to 28 U.S.C. § 1367(a).

6. Venue in the United States District Court, Southern District of Ohio is proper

pursuant to 28 U.S.C. § 1391(b) as the acts complained of occurred in this judicial district.

FACTUAL ALLEGATIONS

7. In the early morning hours of May 25, 2013, Mr. Kelly was a passenger in a

pickup truck being driven southbound on Interstate 71 by his friend, Justin Runck. Mr. Kelly

was asleep in the front passenger seat when State Trooper Bryan Cook signaled Runck to pull

over for a traffic violation.

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8. Runck pulled his pickup truck onto the inside shoulder of the highspeed lane of

Interstate 71. Cooke ordered Runck from his truck and had Runck perform field sobriety tests.

He then handcuffed Runck and arrested him for driving under the influence of alcohol. Cook

placed Runck in the front seat of the police cruiser, which was parked directly behind Runck’s

pickup truck.

9. Mr. Kelly remained asleep in the front passenger seat of the pickup truck.

10. Defendant Sines arrived at the scene, left his vehicle, and stood near Cook’s

cruiser. Cook asked Sines to watch Runck while he went to “wake up the passenger.”

11. Cook opened the driver’s side door of Runck’s pickup in order to awaken Mr.

Kelly. Cook, leaning over the driver’s seat, said “Partner, hey partner.” When Mr. Kelly did not

respond, Cook reached into the truck and shook Mr. Kelly’s arm and shoulder, yelling “Hey,

hey, hey.”

12. Mr. Kelly was startled and flailed his arms over his head. He remained in the

passenger seat of the pickup restrained by his locked seatbelt. Cook stepped back and shouted

“Wake up, wake up, get up.”

13. Sines then ran to the passenger side of Runck’s pickup truck and opened the door.

Sines pointed his taser at Mr. Kelly and said “Sheriff’s Office, show us your hands.” Cook said,

“I know you’re asleep, now get out.”

14. Without giving Mr. Kelly time to comply with these commands, Sines grabbed

the back of Mr. Kelly’s sweatshirt and attempted to pull him out the passenger side of the truck.

Mr. Kelly was restrained by his seatbelt; Sines continued to pull on Mr. Kelly’s sweatshirt so that

his head and torso came outside the truck into a horizontal position.

15. Sines pulled Mr. Kelly so far from the truck that Mr. Kelly’s hands and then his

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feet touched the pavement. But the seatbelt prevented Sines from pulling Mr. Kelly entirely free

of the truck. Sine said “I’ll tase you.”

16. Sines lost his grip on Mr. Kelly’s sweatshirt and he was pulled towards the truck

by his seatbelt. Sines fired his taser at Mr. Kelly. A taser prong struck Mr. Kelly in his right

eye. Mr. Kelly slumped into a sitting position in the open truck door, still restrained by his

seatbelt.

17. Sines told Mr. Kelly to “Get on the ground, get on the ground, now, get on the

ground, I’ll do it again, get on the ground.” While his taser prong was embedded in Mr. Kelly’s

eye, Sines activated his Taser for a second time, sending a second surge of high-voltage

electricity into Mr. Kelly’s eye.

18. Cook then asked Sines, “Has he got a seatbelt around him?” Sines ordered Mr.

Kelly to face away from him. Mr. Kelly complied with this order. Cook then reached through

the driver’s side door of the truck and unfastened Mr. Kelly’s seatbelt. The officers handcuffed

Mr. Kelly and called for a medic to treat his injuries.

19. The taser prong remained in his eye. Mr. Kelly was taken by ambulance to

Fayette Memorial Hospital and then to Ohio State University Hospital where the taser prong was

eventually removed by an eye surgeon in the afternoon. The taser prong damaged the retina of

Mr. Kelly’s eye, resulting in the near-total loss of vision of his right eye.

COUNT I

(42 U.S.C. §1983 - Excessive Force)

(Against Defendant Sines)

20. Plaintiff repeats and re-alleges the allegations contained in paragraphs 1 through 19

as if fully restated herein.

21. Sines had no basis to use any force against Mr. Kelly. Sines used excessive force

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when he pulled Mr. Kelly from Runck’s truck, tased him in the eye, and then tased him again in

the eye knowing that his taser prong was embedded in Mr. Kelly’s eye.

22. Sines’s actions were made under color of state law. They deprived Mr. Kelly of

his right to be free from excessive force under the Fourth and Fourteenth Amendments to the

United States Constitution.

23. Sines’s use of excessive force caused significant injuries to Mr. Kelly, including

permanent loss of vision in his left eye, post-traumatic stress, other psychological injuries, loss of

enjoyment of life, and other injuries.

24. Under 42 U.S.C. §1983, Sines is liable to Mr. Kelly in damages in an amount to

be proven at trial, plus an award of his attorney’s fees.

COUNT II

(42 U.S.C. §1983 - Excessive Force-Failure to Intervene)

(Against Defendant Cook)

25. Plaintiff repeats and re-alleges the allegations contained in paragraphs 1 through

24 as if fully restated herein.

26. Defendant Cook had a duty to prevent Sines from tasering Mr. Kelly.

27. Cook failed to prevent Sines from tasering Mr. Kelly. This failure resulted in

injuries to Mr. Kelly, including permanent loss of vision in his left eye, post-traumatic stress,

other psychological injuries, loss of enjoyment of life, and other injuries.

28. Cook’s actions were made under color of state law. They deprived Mr. Kelly of

his right to be free from excessive force under the Fourth and Fourteenth Amendments to the

United States Constitution.

29. Under 42 U.S. C. §1983, Cook is liable to Mr. Kelly in damages in an amount to

be proven at trial, plus an award of his attorney’s fees.

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COUNT III

(Battery under Ohio Law)

(Against Defendant Sines and Stanforth)

25. Plaintiff repeats and re-alleges the allegations contained in paragraphs 1 through

24 above as if fully restated herein.

26. Sines’s actions constituted an intentional and unconsented to and unlawful

offensive contact with Mr. Kelly.

27. Sines’s actions were motived by ill-will, hatred, and contempt towards Mr. Kelly,

and were therefore malicious.

28. Under Ohio law, Sines is liable to Mr. Kelly for compensatory and punitive

damages for battery in an amount to be proven at trial.

29. Under Ohio law, Defendant Vernon P. Stanforth is liable under the doctrine of

respondeat superior for the damages caused by his employee, Deputy Clinton Sines.

COUNT IV

(Negligent Retention and Supervision)

(Against Defendant Stanforth)

30. Plaintiff repeats and re-alleges the allegations contained in paragraphs 1 through

29 above as if fully restated herein.

31. In 1999, Deputy Sines was given a disciplinary letter for unprofessional conduct

and failure to perform his duties. In 2010, he was given two reprimands for neglect of duty. In

2011, Sines was sued for violating the constitutional rights of an 18-year old female during a

traffic stop. Bases on these and other incident, Defendant Sheriff Vernon P. Stanforth knew or

should have known that Sines was an incompetent and untrustworthy employee.

32. Stanforth negligently failed to properly train, supervise, and discipline Sines and

negligently retained Sines as his employee.

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33. Stanforth’s negligence was the proximate cause of the injuries inflicted by Sines

on Mr. Kelly.

34. Under Ohio law, Stanforth is liable in damages to Mr. Kelly in an amount to be

proven at trial.

WHEREFORE, Plaintiff Matthew D. Kelly demands judgment against Defendants as

follows:

i. On Count I, an award of compensatory damages against Defendant Clinton E. Sines in

an amount to be proven at trial that is in excess of $5,000,000.00;

ii. On Count II, an award of compensatory damages against Defendant Bryan Cook in an

amount to be proven at trial that is in excess of $5,000,000.00;

iii. On Count III, an award of compensatory damages against Defendants Sines and

Stanforth in an amount to be proven at trial that is in excess of $5,000,000.00 and an

award of punitive damages in an amount to be proven at trial;

iv. On Count IV on Count I, an award of compensatory damages against Defendant

Stanforth in an amount to be proven at trial that is in excess of $5,000,000.00;

v. On all Counts, an award of his attorneys’ fees and the costs of this action; and

vi. On all Counts, such other relief as he may be entitled to in law or equity.

Respectfully submitted,

/s/ Jeffrey Albert Witt

Jeffrey A. Witt (0066274)

119 E. Court Street

Cincinnati, Ohio 45202

(513) 421-5297

Facsimile: (513) 721-5824

[email protected]

Trial Attorney for Plaintiff

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JURY DEMAND

Plaintiff respectfully demands a trial by jury of all issues so triable.

/s/ Jeffrey Albert Witt_________

Jeffrey Albert Witt (#0066274)

Counsel for Plaintiff

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JS 44 (Rev. 12/12) CIVIL COVER SHEETThe JS 44 civil cover sheet and the information contained herein neither replace nor supplement the filing and service of pleadings or other papers as required by law, except asprovided by local rules of court. This form, approved by the Judicial Conference of the United States in September 1974, is required for the use of the Clerk of Court for thepurpose of initiating the civil docket sheet. (SEE INSTRUCTIONS ON NEXT PAGE OF THIS FORM.)

I. (a) PLAINTIFFS DEFENDANTS

(b) County of Residence of First Listed Plaintiff County of Residence of First Listed Defendant(EXCEPT IN U.S. PLAINTIFF CASES) (IN U.S. PLAINTIFF CASES ONLY)

NOTE: IN LAND CONDEMNATION CASES, USE THE LOCATION OF THE TRACT OF LAND INVOLVED.

(c) Attorneys (Firm Name, Address, and Telephone Number) Attorneys (If Known)

II. BASIS OF JURISDICTION (Place an “X” in One Box Only) III. CITIZENSHIP OF PRINCIPAL PARTIES (Place an “X” in One Box for Plaintiff(For Diversity Cases Only) and One Box for Defendant)

’ 1 U.S. Government ’ 3 Federal Question PTF DEF PTF DEFPlaintiff (U.S. Government Not a Party) Citizen of This State ’ 1 ’ 1 Incorporated or Principal Place ’ 4 ’ 4

of Business In This State

’ 2 U.S. Government ’ 4 Diversity Citizen of Another State ’ 2 ’ 2 Incorporated and Principal Place ’ 5 ’ 5Defendant (Indicate Citizenship of Parties in Item III) of Business In Another State

Citizen or Subject of a ’ 3 ’ 3 Foreign Nation ’ 6 ’ 6 Foreign Country

IV. NATURE OF SUIT (Place an “X” in One Box Only)CONTRACT TORTS FORFEITURE/PENALTY BANKRUPTCY OTHER STATUTES

’ 110 Insurance PERSONAL INJURY PERSONAL INJURY ’ 625 Drug Related Seizure ’ 422 Appeal 28 USC 158 ’ 375 False Claims Act’ 120 Marine ’ 310 Airplane ’ 365 Personal Injury - of Property 21 USC 881 ’ 423 Withdrawal ’ 400 State Reapportionment’ 130 Miller Act ’ 315 Airplane Product Product Liability ’ 690 Other 28 USC 157 ’ 410 Antitrust’ 140 Negotiable Instrument Liability ’ 367 Health Care/ ’ 430 Banks and Banking’ 150 Recovery of Overpayment ’ 320 Assault, Libel & Pharmaceutical PROPERTY RIGHTS ’ 450 Commerce

& Enforcement of Judgment Slander Personal Injury ’ 820 Copyrights ’ 460 Deportation’ 151 Medicare Act ’ 330 Federal Employers’ Product Liability ’ 830 Patent ’ 470 Racketeer Influenced and’ 152 Recovery of Defaulted Liability ’ 368 Asbestos Personal ’ 840 Trademark Corrupt Organizations

Student Loans ’ 340 Marine Injury Product ’ 480 Consumer Credit (Excludes Veterans) ’ 345 Marine Product Liability LABOR SOCIAL SECURITY ’ 490 Cable/Sat TV

’ 153 Recovery of Overpayment Liability PERSONAL PROPERTY ’ 710 Fair Labor Standards ’ 861 HIA (1395ff) ’ 850 Securities/Commodities/ of Veteran’s Benefits ’ 350 Motor Vehicle ’ 370 Other Fraud Act ’ 862 Black Lung (923) Exchange

’ 160 Stockholders’ Suits ’ 355 Motor Vehicle ’ 371 Truth in Lending ’ 720 Labor/Management ’ 863 DIWC/DIWW (405(g)) ’ 890 Other Statutory Actions’ 190 Other Contract Product Liability ’ 380 Other Personal Relations ’ 864 SSID Title XVI ’ 891 Agricultural Acts’ 195 Contract Product Liability ’ 360 Other Personal Property Damage ’ 740 Railway Labor Act ’ 865 RSI (405(g)) ’ 893 Environmental Matters’ 196 Franchise Injury ’ 385 Property Damage ’ 751 Family and Medical ’ 895 Freedom of Information

’ 362 Personal Injury - Product Liability Leave Act Act Medical Malpractice ’ 790 Other Labor Litigation ’ 896 Arbitration

REAL PROPERTY CIVIL RIGHTS PRISONER PETITIONS ’ 791 Employee Retirement FEDERAL TAX SUITS ’ 899 Administrative Procedure’ 210 Land Condemnation ’ 440 Other Civil Rights Habeas Corpus: Income Security Act ’ 870 Taxes (U.S. Plaintiff Act/Review or Appeal of ’ 220 Foreclosure ’ 441 Voting ’ 463 Alien Detainee or Defendant) Agency Decision’ 230 Rent Lease & Ejectment ’ 442 Employment ’ 510 Motions to Vacate ’ 871 IRS—Third Party ’ 950 Constitutionality of’ 240 Torts to Land ’ 443 Housing/ Sentence 26 USC 7609 State Statutes’ 245 Tort Product Liability Accommodations ’ 530 General’ 290 All Other Real Property ’ 445 Amer. w/Disabilities - ’ 535 Death Penalty IMMIGRATION

Employment Other: ’ 462 Naturalization Application’ 446 Amer. w/Disabilities - ’ 540 Mandamus & Other ’ 465 Other Immigration

Other ’ 550 Civil Rights Actions’ 448 Education ’ 555 Prison Condition

’ 560 Civil Detainee - Conditions of Confinement

V. ORIGIN (Place an “X” in One Box Only)

’ 1 OriginalProceeding

’ 2 Removed fromState Court

’ 3 Remanded fromAppellate Court

’ 4 Reinstated orReopened

’ 5 Transferred fromAnother District(specify)

’ 6 MultidistrictLitigation

VI. CAUSE OF ACTION

Cite the U.S. Civil Statute under which you are filing (Do not cite jurisdictional statutes unless diversity): Brief description of cause:

VII. REQUESTED IN COMPLAINT:

’ CHECK IF THIS IS A CLASS ACTIONUNDER RULE 23, F.R.Cv.P.

DEMAND $ CHECK YES only if demanded in complaint:JURY DEMAND: ’ Yes ’ No

VIII. RELATED CASE(S) IF ANY (See instructions):

JUDGE DOCKET NUMBERDATE SIGNATURE OF ATTORNEY OF RECORD

FOR OFFICE USE ONLY

RECEIPT # AMOUNT APPLYING IFP JUDGE MAG. JUDGE

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JS 44 Reverse (Rev. 12/12)

INSTRUCTIONS FOR ATTORNEYS COMPLETING CIVIL COVER SHEET FORM JS 44

Authority For Civil Cover Sheet

The JS 44 civil cover sheet and the information contained herein neither replaces nor supplements the filings and service of pleading or other papers asrequired by law, except as provided by local rules of court. This form, approved by the Judicial Conference of the United States in September 1974, isrequired for the use of the Clerk of Court for the purpose of initiating the civil docket sheet. Consequently, a civil cover sheet is submitted to the Clerk ofCourt for each civil complaint filed. The attorney filing a case should complete the form as follows:

I.(a) Plaintiffs-Defendants. Enter names (last, first, middle initial) of plaintiff and defendant. If the plaintiff or defendant is a government agency, use only the full name or standard abbreviations. If the plaintiff or defendant is an official within a government agency, identify first the agency and then the official, giving both name and title.

(b) County of Residence. For each civil case filed, except U.S. plaintiff cases, enter the name of the county where the first listed plaintiff resides at the time of filing. In U.S. plaintiff cases, enter the name of the county in which the first listed defendant resides at the time of filing. (NOTE: In land condemnation cases, the county of residence of the "defendant" is the location of the tract of land involved.)

(c) Attorneys. Enter the firm name, address, telephone number, and attorney of record. If there are several attorneys, list them on an attachment, notingin this section "(see attachment)".

II. Jurisdiction. The basis of jurisdiction is set forth under Rule 8(a), F.R.Cv.P., which requires that jurisdictions be shown in pleadings. Place an "X" in one of the boxes. If there is more than one basis of jurisdiction, precedence is given in the order shown below.United States plaintiff. (1) Jurisdiction based on 28 U.S.C. 1345 and 1348. Suits by agencies and officers of the United States are included here.United States defendant. (2) When the plaintiff is suing the United States, its officers or agencies, place an "X" in this box.Federal question. (3) This refers to suits under 28 U.S.C. 1331, where jurisdiction arises under the Constitution of the United States, an amendment to the Constitution, an act of Congress or a treaty of the United States. In cases where the U.S. is a party, the U.S. plaintiff or defendant code takes precedence, and box 1 or 2 should be marked.Diversity of citizenship. (4) This refers to suits under 28 U.S.C. 1332, where parties are citizens of different states. When Box 4 is checked, the citizenship of the different parties must be checked. (See Section III below; NOTE: federal question actions take precedence over diversity cases.)

III. Residence (citizenship) of Principal Parties. This section of the JS 44 is to be completed if diversity of citizenship was indicated above. Mark thissection for each principal party.

IV. Nature of Suit. Place an "X" in the appropriate box. If the nature of suit cannot be determined, be sure the cause of action, in Section VI below, is sufficient to enable the deputy clerk or the statistical clerk(s) in the Administrative Office to determine the nature of suit. If the cause fits more than one nature of suit, select the most definitive.

V. Origin. Place an "X" in one of the six boxes.Original Proceedings. (1) Cases which originate in the United States district courts.Removed from State Court. (2) Proceedings initiated in state courts may be removed to the district courts under Title 28 U.S.C., Section 1441. When the petition for removal is granted, check this box.Remanded from Appellate Court. (3) Check this box for cases remanded to the district court for further action. Use the date of remand as the filing date.Reinstated or Reopened. (4) Check this box for cases reinstated or reopened in the district court. Use the reopening date as the filing date.Transferred from Another District. (5) For cases transferred under Title 28 U.S.C. Section 1404(a). Do not use this for within district transfers or multidistrict litigation transfers.Multidistrict Litigation. (6) Check this box when a multidistrict case is transferred into the district under authority of Title 28 U.S.C. Section 1407. When this box is checked, do not check (5) above.

VI. Cause of Action. Report the civil statute directly related to the cause of action and give a brief description of the cause. Do not cite jurisdictional statutes unless diversity. Example: U.S. Civil Statute: 47 USC 553 Brief Description: Unauthorized reception of cable service

VII. Requested in Complaint. Class Action. Place an "X" in this box if you are filing a class action under Rule 23, F.R.Cv.P.Demand. In this space enter the actual dollar amount being demanded or indicate other demand, such as a preliminary injunction.Jury Demand. Check the appropriate box to indicate whether or not a jury is being demanded.

VIII. Related Cases. This section of the JS 44 is used to reference related pending cases, if any. If there are related pending cases, insert the docket numbers and the corresponding judge names for such cases.

Date and Attorney Signature. Date and sign the civil cover sheet.

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

UNITED STATES DISTRICT COURTfor the

__________ District of __________

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

Plaintiff(s)

v. Civil Action No.

Defendant(s)

SUMMONS IN A CIVIL ACTION

To: (Defendant’s name and address)

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 youare 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 ofthe Federal Rules of Civil Procedure. The answer or motion must be served on the plaintiff or plaintiff’s attorney,whose name and address are:

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

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

Civil Action No.

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 individual’s 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 individual’s 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:Server’s signature

Printed name and title

Server’s address

Additional information regarding attempted service, etc:

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

UNITED STATES DISTRICT COURTfor the

__________ District of __________

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

Plaintiff(s)

v. Civil Action No.

Defendant(s)

SUMMONS IN A CIVIL ACTION

To: (Defendant’s name and address)

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 youare 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 ofthe Federal Rules of Civil Procedure. The answer or motion must be served on the plaintiff or plaintiff’s attorney,whose name and address are:

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

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

Civil Action No.

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 individual’s 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 individual’s 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:Server’s signature

Printed name and title

Server’s address

Additional information regarding attempted service, etc:

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

UNITED STATES DISTRICT COURTfor the

__________ District of __________

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

Plaintiff(s)

v. Civil Action No.

Defendant(s)

SUMMONS IN A CIVIL ACTION

To: (Defendant’s name and address)

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 youare 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 ofthe Federal Rules of Civil Procedure. The answer or motion must be served on the plaintiff or plaintiff’s attorney,whose name and address are:

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

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

Civil Action No.

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 individual’s 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 individual’s 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:Server’s signature

Printed name and title

Server’s address

Additional information regarding attempted service, etc:

Case: 2:14-cv-00307-GLF-NMK Doc #: 1-4 Filed: 04/02/14 Page: 2 of 2 PAGEID #: 16