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AO 111 (Rev. 12/89) Subpoena to Testify before Grand J RECEIVED | Date BY SERVER SERVED Date | 4 | Je | Looy SERVED ON (PRINT NAMB) . | SERVED BY (PRINT NAME) STATEMENT OF SERVICE FEES SERVICES DECLARATION OF SERVER’ I declare under penalty of perjury under the laws of the United States of America that the foregoing information contained in the Return of Service ‘oe Fees is true and correct. bo Executed on ftv loy bIC Date Signature (lOc Uda re. Blok LA, OAH Address of Server ADDITIONAL INFORMATION 1 “Fees and mileage need not be tendered to the witness upon service of a subpoena issued on behalf of the United States or an officer or agency thereof (Rule 45(c). Federal Rules of Civil Procedures; Rule 17(d), Federal Rules of Criminal Procedure) or on behalf of certain indigent parties and criminal defendants who are unable to pay such costs (28 USC 1825, Rule 17(b) Federal Rules of Criminal Procedure)”.