1

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF INDIANA
SOUTH BEND DIVISION

Taimi Fernandez-Guillot, )
Plaintiff, )
)
vs. ) CAUSE NO: 3:14-cv-1555
)
CRANE CO, a Delaware Corp., )
CRANE COMPOSITES an operating )
Division or group )
AND )
CRANE COMPOSITES, INC. a )
Delaware Corp. )
Defendants ) Jury Trial Demanded


COMPLAINT TORT FOR WRONGFUL TERMINATION

Plaintiff, by counsel, states as her cause of action against the defendant as
follows:
1/ This is an action arising under the Indiana tort doctrine of wrongful
termination commonly referred to as a McClanahan termination. McClanahan v.
Remington Freight Lines, 517 N.E. 2d 390 (1988).
2/ Jurisdiction is based upon diversity of citizenship.
3/ The defendant corporations are foreign corporations admitted to do
business in Indiana and their principle offices are in Stamford Connecticut and
Channahon, Illinois.
4/ The plaintiff resides in Goshen, Indiana.
5/ The plaintiff is an experienced human resources professional holding
both a Bachelors and Masters degree from Florida International University. She
was employed in that capacity in Miami, Florida.
case 3:14-cv-01555-WCL-JEM document 1 filed 05/19/14 page 1 of 6
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6/ On or about October 15, 2013 Ms. Fernandez-Guillot was recruited
for the position of HR Manager at the defendants fiberglass/composite
manufacturing facility in Goshen, Indiana. On December 2, 2013 she was the
successful candidate for the position with an annual base compensation of
$90,000.00 plus bonus. Being a life-long resident of Florida, notwithstanding, she
embraced this new position as an opportunity to professionally advance herself.
She, her husband and their son moved to Goshen, Indiana. Her business card
read Crane Composites Taimi Guillot HR Manager 2424 East Kercher Goshen,
Indiana.
7/ Cranes(NYSE) corporate statement asserts: At Crane, corporate
citizenship is more than a responsibility: its our way of doing business. The
concept of corporate responsibilitywhere companies take responsibility not only
for profits but also for the impact of their activities on the many different
stakeholders with which it interactsis the foundation on which our company was
built and the common thread that ties together all that we do today. Every
leadership conference, every investor presentation and each orientation session for
a new employee begins with a discussion of the ethics on which our Company was
founded, including honesty and fairness in dealings with customers, employees
and even competitors, and the core values of today, which are integrity and
performance with trust and respect.
8/ Cranes ethical spirit is expressed as: The people of Crane are
expected to conduct themselves with honesty and integrity in all facets of their
business lives. Our CEO is not only our Chief Executive Officer but, informally, our
Chief Ethics Officer, and he sets the tone at the top for doing the right thing, the
case 3:14-cv-01555-WCL-JEM document 1 filed 05/19/14 page 2 of 6
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first time, and every time. Performance evaluations of our people include an
assessment of ethical behavior and commitment to Cranes values.
Crane sustains its values through training in its Code of Ethics and in many
specific operational areas, including export controls, anti-corruption,
and workplace harassment. These are not just one-time sessions, but are refreshed
and repeated regularly to complement our ethics education with compliance and
responsibility training. We require that our managers provide regular reports and
certifications that they understand and acknowledge their obligations to comply
with both the spirit and letter of our Code and immediately report any issues that
arises.
9/ The plaintiff was required by Crane to attend and complete corporate
citizenship and ethics training. On January 25, 2014 she completed the required
training to wit: Global Bribery and Corruption Awareness, Crane Code of
Conduct from the Crane Co.s Center for Interactive Compliance Training, and
Avoiding Illegal Competition.
10/ The plaintiffs HR reporting chain consisted of: Robert Burton
Divisional VP HR (Crane Composites); Andrea Frohning Corporate VP HR (Crane
Co); and Max Mitchell CEO Corporate (Crane Co). Her plant report was to Michael
Ridge Plant Manager
11/ A critical function of her job was new employment screening, selecting,
hiring, and current employee audits. A part of that function was the taking and
reviewing of the I-9 Form of the United States Department of Homeland Security
U.S. Citizenship and Immigration Services. And for ensuring and verifying the
case 3:14-cv-01555-WCL-JEM document 1 filed 05/19/14 page 3 of 6
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accuracy of identification documents submitted by prospective and current
employees in support of their I-9 Forms.
12/ As HR manager for the defendants Goshen Plant she was the manager
charged with the duty and responsibility to execute the employer Certification or
rehire reverification, under penalties of perjury.
13/ On February 18, 2014 the plaintiff terminated Jose E. Rodriguez for
providing false identification to obtain employment. During his exit interview with
the plaintiff he told her that most of the plant was, as he put it, illegal. In fact he
had worked before under the name of Efrain Moran. Thereafter, the plaintiff
commenced the verification audit discovering extensive illegal employee at the
Goshen Plant.
14/ Both the plant production manager and her manager Divisional VP
Burton became engaged in this process by her advice.
15/ In April 2014 her direct report Divisional HR VP Robert Burton told
her to get rid of any copies of employee identifications and proofs attached to their
I-9 forms. She refused. During a meeting in the first week of April, 2014
Divisional HR VP Burton directed her to accept any proofs for an I-9 certification
for these new employees whatever, they give youaccept then sign the I-9
dont inspectdont do anything you are not ICE/INS.. just sign. She refused
to sign new employees under these conditions.
16/ As of May 4, 2014 there continued to be undocumented employees in
the Goshen plant and her efforts at following Cranes stated ethical policy was
being thwarted.
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17/ On May 4, 2014 plaintiff sent a communication to Divisional President
Craney in Channahon, Illinois outlining the systemic issues of undocumented
workers at the Goshen plant the plaintiff pleaded her rationale to President
Craney based upon: my main responsibility is to protect our company from
any legal implications while complying and enforcing Cranes Business Ethics and
Compliance with Law Policy CP-102. We have a shared obligation to report any and
all ethical risks to our senior management team, directors and officers to help
foster a culture of honesty and accountability. I want to work for a company that I
am proud of and as our founder, RJ Crane , indoctrinated I am resolved to
conduct my business in the strictest honesty and fairness, to avoid all deception
and trickery
18/ On May 14, 2014, at the Lux Caf in Goshen, Divisional HR VP Burton
terminated the plaintiff saying youre just not a team player. you have
burned enough bridges and our people are not willing to give you a second
chance
19/ In contravention of the public policy of the State of Indiana,
defendants terminated the plaintiff for her refusal to engage in behavior for which
she could have been criminally or civilly liable for perjury regarding required
United States Homeland Security documents for employee hiring and continued
employment
20/ Defendants unlawful actions were intentional with knowledge of the
falsity and accomplished in willful disregard of her rights protected by Indiana
common law.
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21/ Plaintiff has suffered lost income and will continue to incur lost
income and suffered emotional pain and continues to suffer emotional pain
resulting from defendants willful unlawful conduct.
22/ Plaintiff requests that her trial be conducted before a jury.
REQUESTED RELIEF
WHEREFORE, PLAINTIFF, by counsel respectfully requests that this Court
award judgment in the amount of $1,500,000.00 for economic loss and
compensatory damages, and $500,000.00 in punitive damages to be awarded and
determined by Indiana law.


Respectfully submitted,

s/ Raymond J. Hafsten, Jr.
Raymond J. Hafsten, Jr.
Of Counsel


s/ John H. Haskin
John H. Haskin

s/ Bradley L. Wilson
Bradley L. Wilson
JOHN H. HASKIN & ASSOCIATES
255 North Alabama Street 2
nd
Floor
Indianapolis, IN 46202
317-955-9500
FAX 317-955-2570
hafsten@sbcglobal.net
jhaskin@jhaskinlaw.com
bwilson@jhaskinlaw.com
case 3:14-cv-01555-WCL-JEM document 1 filed 05/19/14 page 6 of 6
OJS 44 (Rev. 12/07)
CIVIL COVER SHEET
The 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 as
provided 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 the purpose
of initiating the civil docket sheet. (SEE INSTRUCTIONS ON THE REVERSE OF THE FORM.)
I. (a) PLAINTIFFS DEFENDANTS
TAIMI FERNANDEZ-GUILLOT CRANE CO., et al.
(b) County of Residence of First Listed Plaintiff Elkhart 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
LAND INVOLVED.
Attorneys (Firm Name, Address, and Telephone Number) Attorneys (If Known)
John H. Haskin / Raymond J. Hafsten, Jr. / Bradley L. Wilson
JOHN H. HASKIN & ASSOCIATES
255 North Alabama Street, 2 Floor, Indianapolis, IN 46204 (317) 955-9500
nd
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 DEF
Plaintiff (U.S. Government Not a Party) Citizen of This State X 1 1 Incorporated or Principal Place 4 4
of Business In This State
2 U.S. Government X 4 Diversity Citizen of Another State 2 X 2 Incorporated and Principal Place 5 X 5
Defendant
(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 610 Agriculture 422 Appeal 28 USC 158 400 State Reapportionment
120 Marine 310 Airplane 362 Personal Injury - 620 Other Food & Drug 423 Withdrawal 410 Antitrust
130 Miller Act 315 Airplane Product Med. Malpractice 625 Drug Related Seizure 28 USC 157 430 Banks and Banking
140 Negotiable Instrument Liability 365 Personal Injury - of Property 21 USC 881 450 Commerce
150 Recovery of Overpayment 320 Assault, Libel & Product Liability 630 Liquor Laws PROPERTY RIGHTS 460 Deportation
& Enforcement of Judgment Slander 368 Asbestos Personal 640 R.R. & Truck 820 Copyrights 470 Racketeer Influenced and
151 Medicare Act 330 Federal Employers Injury Product 650 Airline Regs. 830 Patent Corrupt Organizations
152 Recovery of Defaulted Liability Liability 660 Occupational 840 Trademark 480 Consumer Credit
Student Loans 340 Marine PERSONAL PROPERTY Safety/Health 490 Cable/Sat TV
(Excl. Veterans) 345 Marine Product 370 Other Fraud 690 Other 810 Selective Service
153 Recovery of Overpayment Liability 371 Truth in Lending LABOR SOCIAL SECURITY 850 Securities/Commodities/
of Veterans Benefits 350 Motor Vehicle 380 Other Personal 710 Fair Labor Standards 861 HIA (1395ff) Exchange
160 Stockholders Suits 355 Motor Vehicle Property Damage Act 862 Black Lung (923) 875 Customer Challenge
190 Other Contract Product Liability 385 Property Damage 720 Labor/Mgmt. Relations 863 DIWC/DIWW (405(g)) 12 USC 3410
195 Contract Product Liability 360 Other Personal Product Liability 730 Labor/Mgmt.Reporting 864 SSID Title XVI 890 Other Statutory Actions
196 Franchise Injury & Disclosure Act 865 RSI (405(g)) 891 Agricultural Acts
REAL PROPERTY CIVIL RIGHTS PRISONER PETITIONS 740 Railway Labor Act FEDERAL TAX SUITS 892 Economic Stabilization Act
210 Land Condemnation 441 Voting 510 Motions to Vacate 790 Other Labor Litigation 870 Taxes (U.S. Plaintiff 893 Environmental Matters
220 Foreclosure X 442 Employment Sentence 791 Empl. Ret. Inc. or Defendant) 894 Energy Allocation Act
230 Rent Lease & Ejectment 443 Housing/ Habeas Corpus: Security Act 871 IRSThird Party 895 Freedom of Information
240 Torts to Land Accommodations 530 General 26 USC 7609 Act
245 Tort Product Liability 444 Welfare 535 Death Penalty IMMIGRATION 900Appeal of Fee Determination
290 All Other Real Property 445 Amer. w/Disabilities - 540 Mandamus & Other 462 Naturalization Application Under Equal Access
Employment 550 Civil Rights 463 Habeas Corpus - to Justice
446 Amer. w/Disabilities - 555 Prison Condition Alien Detainee 950 Constitutionality of
Other 465 Other Immigration State Statutes
440 Other Civil Rights Actions
V. ORIGIN
Transferred from
another district
(specify)
Appeal to District
Judge from
Magistrate
Judgment
(Place an X in One Box Only)
X 1 Original
Proceeding
2 Removed from
State Court
3 Remanded from
Appellate Court
4 Reinstated or
Reopened
5 6 Multidistrict
Litigation
7
VI. CAUSE OF ACTION
Cite the U.S. Civil Statute under which you are filing (Do not cite jurisdictional statutes unless diversity):
McClanahan v. Remington Freight Lines, 517 N.E. 2d 390 (1988), 28 USC 1332
Brief description of cause:
Plaintiff alleges discrimination in employment
VII. REQUESTED IN
COMPLAINT:
CHECK IF THIS IS A CLASS ACTION
UNDER F.R.C.P. 23
DEMAND $ CHECK YES only if demanded in complaint:
JURY DEMAND: X Yes No
VIII. RELATED CASE(S)
IF ANY
(See instructions):
JUDGE DOCKET NUMBER
DATE SIGNATURE OF ATTORNEY OF RECORD
May 19, 2014 s/ John H. Haskin
FOR OFFICE USE ONLY
RECEIPT # AMOUNT APPLYING IFP JUDGE MAG. JUDGE
case 3:14-cv-01555-WCL-JEM document 1-1 filed 05/19/14 page 1 of 2
JS 44 Reverse (Rev. 12/07)
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 as required
by law, except as provided 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 the purpose of initiating the civil docket sheet. Consequently, a civil cover sheet is submitted to the Clerk of Court 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.)
Attorneys. Enter the firm name, address, telephone number, and attorney of record. If there are several attorneys, list them on an attachment, noting
in this section (see attachment).
II. Jurisdiction. The basis of jurisdiction is set forth under Rule 8(a), F.R.C.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; 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 this section
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 clerks 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 seven 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.
Appeal to District Judge from Magistrate Judgment. (7) Check this box for an appeal from a magistrate judges decision.
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 dollar amount (in thousands of dollars) 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.
case 3:14-cv-01555-WCL-JEM document 1-1 filed 05/19/14 page 2 of 2
AO 440 (Rev. 12/09) Summons in a Civil Action
UNITED STATES DISTRICT COURT
for the
Northern District of Indiana
TAIMI FERNANDEZ-GUILLOT
)
)
)
)
)
)
)
Plaintiff
v. Civil Action No. 3:14-cv-1555
CRANE CO., et al.
Defendant
SUMMONS IN A CIVIL ACTION
To: (Defendants name and address)
CRANE CO., a Delaware Corp.
c/o C.T. Corporation System
150 West Market Street, Suite 800
Indianapolis, IN 46204
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 you are 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 of the Federal Rules of Civil Procedure. The answer or motion must be
served on the plaintiff or plaintiffs attorney, whose name and address are:
John H. Haskin / Raymond J. Hafsten, Jr. / Bradley L. Wilson
JOHN H. HASKIN & ASSOCIATES
255 North Alabama Street, 2 Floor
nd
Indianapolis, IN 46204
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
case 3:14-cv-01555-WCL-JEM document 1-2 filed 05/19/14 page 1 of 6
AO 440 (Rev. 12/09) 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 individuals 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 individuals 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:
Servers signature
Printed name and title
Servers address
Additional information regarding attempted service, etc:
case 3:14-cv-01555-WCL-JEM document 1-2 filed 05/19/14 page 2 of 6
AO 440 (Rev. 12/09) Summons in a Civil Action
UNITED STATES DISTRICT COURT
for the
Northern District of Indiana
TAIMI FERNANDEZ-GUILLOT
)
)
)
)
)
)
)
Plaintiff
v. Civil Action No. 3:14-cv-1555
CRANE CO., et al.
Defendant
SUMMONS IN A CIVIL ACTION
To: (Defendants name and address)
CRANE COMPOSITES an operating Division or group
c/o C.T. Corporation System
150 West Market Street, Suite 800
Indianapolis, IN 46204
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 you
are 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 of
the Federal Rules of Civil Procedure. The answer or motion must be served on the plaintiff or plaintiffs attorney,
whose name and address are:
John H. Haskin / Raymond J. Hafsten, Jr. / Bradley L. Wilson
JOHN H. HASKIN & ASSOCIATES
255 North Alabama Street, 2 Floor
nd
Indianapolis, IN 46204
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
case 3:14-cv-01555-WCL-JEM document 1-2 filed 05/19/14 page 3 of 6
AO 440 (Rev. 12/09) 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 individuals 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 individuals 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:
Servers signature
Printed name and title
Servers address
Additional information regarding attempted service, etc:
case 3:14-cv-01555-WCL-JEM document 1-2 filed 05/19/14 page 4 of 6
AO 440 (Rev. 12/09) Summons in a Civil Action
UNITED STATES DISTRICT COURT
for the
Northern District of Indiana
TAIMI FERNANDEZ-GUILLOT )
)
)
)
)
)
)
Plaintiff
v. Civil Action No. 3:14-cv-1555
CRANE CO., et al.
Defendant
SUMMONS IN A CIVIL ACTION
To: (Defendants name and address)
CRANE COMPOSITES, INC.
c/o C.T. Corporation System
150 West Market Street, Suite 800
Indianapolis, IN 46204
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 you
are 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 of
the Federal Rules of Civil Procedure. The answer or motion must be served on the plaintiff or plaintiffs attorney,
whose name and address are:
John H. Haskin / Raymond J. Hafsten, Jr. / Bradley L. Wilson
JOHN H. HASKIN & ASSOCIATES
255 North Alabama Street, 2 Floor
nd
Indianapolis, IN 46204
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
case 3:14-cv-01555-WCL-JEM document 1-2 filed 05/19/14 page 5 of 6
AO 440 (Rev. 12/09) 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 individuals 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 individuals 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:
Servers signature
Printed name and title
Servers address
Additional information regarding attempted service, etc:
case 3:14-cv-01555-WCL-JEM document 1-2 filed 05/19/14 page 6 of 6