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Form B 250f - Summons In A Chapter 15 Case Seeking Recognition Of A Foreign Nonmain Proceeding Page 2

CERTIFICATE OF SERVICE

(name), certify that service of this summons and a copy of the

petition for recognition was made on

(date) by:

Mail service: Regular, first class United States mail, postage fully pre-paid, addressed to:

Personal Service: By leaving the summons and petition with the party in interest to the petition

or with an officer or agent of the party in interest at:

Residence Service: By leaving the summons and petition with the following adult at:

Certified Mail Service on an Insured Depository Institution: By sending the process by certified

mail addressed to the following officer of the depository institution at:

State Law: The summons and petition were served pursuant to the laws of the State of

as follows: [Describe briefly]

Service in a Foreign Country: The summons and petition were served in a foreign country on

an individual as provided by Fed. R. Civ. Proc 4(f), as incorporated by Fed. R. Bankr. P.

7004(a), or on a corporation as provided by Fed. R. Civ. P. 4(h), also incorporated by Fed. R.

Bankr. P. 7004(a), as follows: [Describe briefly]

If service was made by personal service, by residence service, pursuant to state law, or in a foreign

country, I further certify that I am, and at all times during the service of process was, not less than 18 years of

age and not a party to the matter concerning which service of process was made.

Under penalty of perjury under the laws of the United States, I declare that the foregoing is true and

correct.

Date

Signature

Print Name :

Business Address:

If service is made in a foreign country pursuant to Fed. R. Civ. P. 4(f)(2),(3), attach a receipt signed by the addressee or

other evidence that the summons and petition were delivered to the addressee. Fed. R. Civ. P. 4(l)(2), as incorporated by

Fed. R. Bankr. P. 7004(a).

Form B 250f - Summons In A Chapter 15 Case Seeking Recognition Of A Foreign Nonmain Proceeding Page 2