7/27/2019 KP Form No. 9 Page 2

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KP Form No. 9

Page 2

Republic of the Philippines

Province of Camarines SurMunicipality 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)

7/27/2019 KP Form No. 9 Page 2

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