KP Form No.

9
Page 2

Republic of the Philippines

Province of Camarines Sur
Municipality of NABUA
Barangay SAN ROQUE POBLACION

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)