Republic of the Philippines
Province of Leyte
Municipality of Palompon
Barangay San Isidro
-o0o-
OFFICER’S RETURN
I served this summons upon respondent on the
day of , 20 ; and upon respondent
on the day of , 20 by:
Respondent’s
1. handling to him/them said summons in person,
or
2. handling to him/them said summons and he/
they refuse to received 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)