KP Form No.

9
Page 2
Republic of the Philippines
Province of Camarines Sur
Municipality of Lupi
Barangay _____________________

OFFICERS RETURN
I served this summons upon respondent ___________________ on the _______ day of
________, 20______, and upon respondent ______________ on the _________ day of
________________, 20_____, by: ( Write name/s of respondent/s before mode by which he/they
was/were served.)
Respondent/s
________________

1.

handing to him/them said summons and person,

or

________________

2.

handing to him/them said summons and he/they

refused to serve it, or

________________

3.

leaving said summons at his/their dwelling

with ______________________________
(name)
a person of suitable age and discretion residing
therein, or

________________

4.

leaving said summons at his/their office/place of

business with ___________________________
(name)
a competent person in charge thereof.

____________________
Officer
Received by Respondent/s/representative/s:
_______________________
(Signature)

___________________________
(Date)

_______________________
(Signature)

___________________________
(Date)