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Case 2:20-cv-00038-SMJ ECF No. 1 filed 01/22/20 PageID.

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1 Stuart R. Dunwoody, WSBA No. 13948


Davis Wright Tremaine LLP
2 920 Fifth Avenue, Suite 3300
Seattle, WA 98104-1610
3 Telephone: 206-757-8034
Facsimile: 206-757-7034
4

5
6
7 IN THE UNITED STATES DISTRICT COURT
FOR THE EASTERN DISTRICT OF WASHINGTON
8
WASHINGTON STATE UNIVERSITY,
9
Plaintiff, No. 2:20-cv-00038
10
v. COMPLAINT FOR PATENT
11 INFRINGEMENT
PRO ORCHARD MANAGEMENT,
12 LLC, a Washington limited liability
company, and APPLE KING, LLC, a
13 Washington limited liability company,

14 Defendants.

15
16 Plaintiff Washington State University (“WSU”), for its complaint against
Defendants Pro Orchard Management, LLC and Apple King, LLC alleges as
17
follows:
18
NATURE OF THE ACTION
19
1. This is an action for patent infringement arising under the patent laws
20 of the United States, Title 35 of the United States Code. Defendants have
21 infringed and are continuing to infringe a plant patent that WSU owns, U.S. Plant

22 Patent No. 21,710. Plant Patent No. 21,710 protects an apple cultivar developed
by WSU known as WA 2. Pro Orchard Management, LLC has infringed Plant
23

Davis Wright Tremaine LLP


L AW O FFICE S
COMPLAINT - 1 920 Fifth Avenue, Suite 3300
Seattle, WA 98104-1610
4840-9570-2193v.1 0067901-000136 206.622.3150 main · 206.757.7700 fax
Case 2:20-cv-00038-SMJ ECF No. 1 filed 01/22/20 PageID.2 Page 2 of 7

1 Patent No. 21,710 by asexually reproducing and growing WA 2 apple trees and by

2 harvesting WA 2 apples and consigning them to Apple King, LLC for sale. Apple
King, LLC has infringed Plant Patent No. 21,710 by selling WA 2 apples that
3
unlicensed growers such as Pro Orchard Management, LLC have consigned to it
4
for sale. In addition, Pro Orchard Management, LLC and, on information and
5
belief, Apple King, LLC have induced infringement of Plant Patent No. 21,710 by
6 providing WA 2 budwood to unlicensed persons who have used the budwood to
7 asexually reproduce WA 2 apple trees. WSU seeks redress for Defendants’

8 infringing acts.

9 THE PARTIES
2. Washington State University is a state university of the State of
10
Washington.
11
3. Pro Orchard Management, LLC is a Washington state limited liability
12
company with its principal place of business at 3581 Mapleway Road, Yakima,
13 WA 98908-9645. The members of Pro Orchard Management, LLC are Patricia
14 Keller, Raymond Keller, the Testamentary Trust of Richard Keller, and J. Michael

15 Saunders. Pro Orchard Management, LLC is an apple grower.


4. Apple King, LLC is a Washington state limited liability company with
16
its principal place of business at 3581 Mapleway Road, Yakima, WA 98908-9645.
17
Apple King, LLC has the same members as Pro Orchard Management, LLC:
18
Patricia Keller, Raymond Keller, the Testamentary Trust of Richard Keller, and J.
19 Michael Saunders. Apple King, LLC is an apple packer.
20 JURISDICTION AND VENUE
21 5. This Court has subject-matter jurisdiction under 28 U.S.C. §§ 1331

22 and 1338(a) because this action arises under the patent laws of the United States.

23

Davis Wright Tremaine LLP


L AW O FFICE S
COMPLAINT - 2 920 Fifth Avenue, Suite 3300
Seattle, WA 98104-1610
4840-9570-2193v.1 0067901-000136 206.622.3150 main · 206.757.7700 fax
Case 2:20-cv-00038-SMJ ECF No. 1 filed 01/22/20 PageID.3 Page 3 of 7

1 6. This Court has personal jurisdiction over Defendants because they


2 reside and do business within this judicial district.
3 7. Venue is proper in this judicial district under 28 U.S.C. § 1400(b),
4 because Defendants reside, have regular and established places of business, and
5 have committed acts of infringement within this district.
6 FACTUAL BACKGROUND
7 8. WSU began its apple breeding program in 1994 to develop new

8 varieties of apples suited to the unique climate of central Washington and make
them available to Washington growers. WSU seeks to breed apple varieties with
9
improved eating quality, particularly focusing on outstanding texture and
10
storability.
11
9. WA 2 is the first apple variety that WSU released to the public from
12 its apple breeding program. WSU Professor Bruce Barritt bred WA 2 in 1994 from
13 a cross of the Splendour and Gala cultivars. Dr. Barritt and his colleagues then

14 spent five years evaluating and developing the cultivar.


10. In March 2009, Dr. Barritt assigned his invention of the WA 2 cultivar
15
to WSU and filed an application with the United States Patent & Trademark office
16
seeking a plant patent on it. The United States Patent & Trademark Office issued
17
U.S. Plant Patent No. 21,710, which discloses and claims the WA 2 cultivar, on
18 February 15, 2011. A copy of Plant Patent No. 21,710 is attached to this
19 Complaint as Exhibit A.

20 11. Before Plant Patent No. 21,710 issued, WSU assigned the patent
application to Washington State University Research Foundation (“WSURF”), a
21
non-profit corporation that used to handle technology licensing for WSU. When
22
Plant Patent No. 21,710 issued, therefore, it was owned by WSURF. WSURF
23

Davis Wright Tremaine LLP


L AW O FFICE S
COMPLAINT - 3 920 Fifth Avenue, Suite 3300
Seattle, WA 98104-1610
4840-9570-2193v.1 0067901-000136 206.622.3150 main · 206.757.7700 fax
Case 2:20-cv-00038-SMJ ECF No. 1 filed 01/22/20 PageID.4 Page 4 of 7

1 assigned Plant Patent No. 21,710 to WSU on July 1, 2013, and WSU continues to

2 own the patent.


12. In February 2011, WSURF began entering into Non-Exclusive
3
License Agreements for WA 2 with Washington growers. These Non-Exclusive
4
License Agreements give the licensed grower a non-exclusive right to “purchase,
5
plant, grow and asexually propagate” WA 2, but only within the “Territory,” and to
6 sell fruit from WA 2 trees anywhere in the world. The Non-Exclusive License
7 Agreements define “Territory” as land identified by the licensed grower in an

8 earlier “Evaluation Agreement” between the licensed grower and WSURF, and any
other land owned by the licensed grower. The Non-Exclusive License Agreements
9
explicitly state that a licensed grower was permitted to propagate WA 2 plants only
10
on land that was owned by the licensed grower and under its control. The Non-
11
Exclusive License Agreements also “strictly prohibit[]” licensed growers from
12 “selling Licensed Plants or transferring Licensed Plants outside of the Territory.”
13 13. Neither Pro Orchard Management, LLC nor Apple King, LLC has a

14 license from WSURF or from WSU that grants either of them any rights under
Plant Patent No. 21,710 or to use WA 2 in any way.
15
14. One of the growers to whom WSURF granted a Non-Exclusive
16
License Agreement for WA 2 is Keller Fruit, Inc. The shareholders of Keller Fruit,
17
Inc. are identical to the members of Pro Orchard Management, LLC and of Apple
18 King, LLC: Patricia Keller, Raymond Keller, the Testamentary Trust of Richard
19 Keller, and J. Michael Saunders. But Keller Fruit, Inc. is an entity that is separate

20 and distinct from both Pro Orchard Management, LLC and Apple King, LLC, and
the Non-Exclusive License Agreement to Keller Fruit, Inc. did not grant any rights
21
to Pro Orchard Management, LLC or to Apple King, LLC to propagate, use or sell
22
WA apple trees or apples. According to J. Michael Saunders, Keller Fruit, Inc.
23

Davis Wright Tremaine LLP


L AW O FFICE S
COMPLAINT - 4 920 Fifth Avenue, Suite 3300
Seattle, WA 98104-1610
4840-9570-2193v.1 0067901-000136 206.622.3150 main · 206.757.7700 fax
Case 2:20-cv-00038-SMJ ECF No. 1 filed 01/22/20 PageID.5 Page 5 of 7

1 closed down its operations “around 2004, 2005,” long before it was granted a Non-

2 Exclusive License.
15. Pro Orchard Management, LLC has asexually reproduced WA 2 apple
3
trees, induced third parties to asexually reproduce WA 2 apple trees by providing
4
WA 2 scionwood to them, grown WA 2 apple trees, harvested WA 2 apples, and
5
induced the sale of WA 2 apples by consigning them for sale.
6 16. Apple King, LLC has sold WA 2 apples that unlicensed growers such
7 as Pro Orchard Management, LLC have consigned to it for sale. Also, on

8 information and belief, Apple King, LLC has induced third parties to asexually
reproduce WA 2 apple trees by providing WA 2 scionwood to them.
9
17. On information and belief, Pro Orchard Management, LLC and Apple
10
King, LLC have been aware of Plant Patent No. 21,710 since shortly after it issued
11
on February 15, 2011.
12 CLAIM FOR RELIEF – PATENT INFRINGEMENT
13 18. Pro Orchard Management, LLC and Apple King, LLC have directly
14 infringed Plant Patent No. 21,710 through their actions alleged above, in violation

15 of 35 U.S.C. §§ 163 and 271(a).


19. Pro Orchard Management, LLC and Apple King, LLC have actively
16
induced infringement of Plant Patent No. 21,710 through their actions alleged
17
above, with knowledge of U.S. Plant Patent No. 21,710 and knowledge that their
18
actions are encouraging infringement, in violation of 35 U.S.C. §§ 163 and 271(b).
19 20. Defendants’ infringing conduct was and continues to be without
20 authority, consent, or license.

21 21. Defendants infringed Plant Patent No. 21,710 despite an objectively


high likelihood that their actions constituted infringement. Defendants’
22
infringement of Plant Patent No. 21,710 therefore has been willful.
23

Davis Wright Tremaine LLP


L AW O FFICE S
COMPLAINT - 5 920 Fifth Avenue, Suite 3300
Seattle, WA 98104-1610
4840-9570-2193v.1 0067901-000136 206.622.3150 main · 206.757.7700 fax
Case 2:20-cv-00038-SMJ ECF No. 1 filed 01/22/20 PageID.6 Page 6 of 7

1 22. WSU has suffered irreparable harm, and will continue to suffer

2 irreparable harm, unless Defendants are permanently enjoined from infringing


Plant Patent No. 21,710. WSU has no adequate remedy at law.
3
23. WSU is entitled to recover from Defendants the damages it has
4
sustained as a result of Defendants’ infringing acts in an amount WSU will prove
5
at trial, but in no event less than a reasonable royalty, together with interest and
6 costs, as well as attorneys’ fees, should the Court deem the case exceptional or the
7 infringement willful.

8 PRAYER FOR RELIEF

9 WHEREFORE, WSU prays for a Judgment in its favor and against


Defendants, and respectfully requests that this Court:
10
1. Award WSU damages adequate to compensate for Defendants’
11
infringement of Plant Patent No. 21,710 (including supplemental damages for any
12
post-verdict patent infringement up until entry of the final judgment with an
13 accounting as needed, together with prejudgment and post-judgment interest on the
14 damages awarded; all of these damages to be enhanced in an amount up to treble

15 the amount of compensatory damages pursuant to 35 U.S.C. § 284);


2. Enter a permanent injunction (a) enjoining Defendants, their officers,
16
agents, servants, employees, and attorneys, and other persons who are in active
17
concert or participation with any of the foregoing, from further acts of
18
infringement of Plant Patent No. 21,710, and (b) directing Defendants, their
19 officers, agents, servants, employees, and attorneys, and other persons who are in
20 active concert or participation with any of the foregoing, to destroy or return to

21 WSU all WA 2 plants and plant material within their possession, custody, or
control;
22
3. Find this case exceptional under 35 U.S.C. § 285;
23

Davis Wright Tremaine LLP


L AW O FFICE S
COMPLAINT - 6 920 Fifth Avenue, Suite 3300
Seattle, WA 98104-1610
4840-9570-2193v.1 0067901-000136 206.622.3150 main · 206.757.7700 fax
Case 2:20-cv-00038-SMJ ECF No. 1 filed 01/22/20 PageID.7 Page 7 of 7

1 4. Award WSU its costs and attorneys’ fees; and

2 5. Grant such other and further relief as it deems just and proper.

3 DATED this 22nd day of January, 2020.

4 Davis Wright Tremaine LLP


Attorneys for Washington State University
5
6
By: s/ Stuart R. Dunwoody
7 Stuart R. Dunwoody, WSBA No. 13948

8 920 Fifth Avenue, Suite 3300


Seattle, WA 98104-1610
9
Telephone: 206-757-8034
10 Facsimile: 206-757-7034
stuartdunwoody@dwt.com
11
12
13

14
15
16

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19

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Davis Wright Tremaine LLP


L AW O FFICE S
COMPLAINT - 7 920 Fifth Avenue, Suite 3300
Seattle, WA 98104-1610
4840-9570-2193v.1 0067901-000136 206.622.3150 main · 206.757.7700 fax
Case 2:20-cv-00038-SMJ ECF No. 1-1 filed 01/22/20 PageID.8 Page 1 of 9

EXHIBIT A

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JS 44 (Rev. 02/19) 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 NEXT PAGE OF THIS FORM.)

I. (a) PLAINTIFFS DEFENDANTS


WASHINGTON STATE UNIVERSITY PRO ORCHARD MANAGEMENT, LLC and APPLE KING, LLC

(b) County of Residence of First Listed Plaintiff Whitman 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 TRACT OF LAND INVOLVED.

(c) Attorneys (Firm Name, Address, and Telephone Number) Attorneys (If Known)

Stuart Dunwoody, Davis Wright Tremaine LLP


920 Fifth Ave., #3300, Seattle, WA 98104; 206-757-8034

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 ’ 1 ’ 1 Incorporated or Principal Place ’ 4 ’ 4
of Business In This State

’ 2 U.S. Government ’ 4 Diversity Citizen of Another State ’ 2 ’ 2 Incorporated and Principal Place ’ 5 ’ 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) Click here for: Nature of Suit Code Descriptions.
CONTRACT TORTS FORFEITURE/PENALTY BANKRUPTCY OTHER STATUTES
’ 110 Insurance PERSONAL INJURY PERSONAL INJURY ’ 625 Drug Related Seizure ’ 422 Appeal 28 USC 158 ’ 375 False Claims Act
’ 120 Marine ’ 310 Airplane ’ 365 Personal Injury - of Property 21 USC 881 ’ 423 Withdrawal ’ 376 Qui Tam (31 USC
’ 130 Miller Act ’ 315 Airplane Product Product Liability ’ 690 Other 28 USC 157 3729(a))
’ 140 Negotiable Instrument Liability ’ 367 Health Care/ ’ 400 State Reapportionment
’ 150 Recovery of Overpayment ’ 320 Assault, Libel & Pharmaceutical PROPERTY RIGHTS ’ 410 Antitrust
& Enforcement of Judgment Slander Personal Injury ’ 820 Copyrights ’ 430 Banks and Banking
’ 151 Medicare Act ’ 330 Federal Employers’ Product Liability ’ 830 Patent ’ 450 Commerce
’ 152 Recovery of Defaulted Liability ’ 368 Asbestos Personal ’ 835 Patent - Abbreviated ’ 460 Deportation
Student Loans ’ 340 Marine Injury Product New Drug Application ’ 470 Racketeer Influenced and
(Excludes Veterans) ’ 345 Marine Product Liability ’ 840 Trademark Corrupt Organizations
’ 153 Recovery of Overpayment Liability PERSONAL PROPERTY LABOR SOCIAL SECURITY ’ 480 Consumer Credit
of Veteran’s Benefits ’ 350 Motor Vehicle ’ 370 Other Fraud ’ 710 Fair Labor Standards ’ 861 HIA (1395ff) ’ 485 Telephone Consumer
’ 160 Stockholders’ Suits ’ 355 Motor Vehicle ’ 371 Truth in Lending Act ’ 862 Black Lung (923) Protection Act
’ 190 Other Contract Product Liability ’ 380 Other Personal ’ 720 Labor/Management ’ 863 DIWC/DIWW (405(g)) ’ 490 Cable/Sat TV
’ 195 Contract Product Liability ’ 360 Other Personal Property Damage Relations ’ 864 SSID Title XVI ’ 850 Securities/Commodities/
’ 196 Franchise Injury ’ 385 Property Damage ’ 740 Railway Labor Act ’ 865 RSI (405(g)) Exchange
’ 362 Personal Injury - Product Liability ’ 751 Family and Medical ’ 890 Other Statutory Actions
Medical Malpractice Leave Act ’ 891 Agricultural Acts
REAL PROPERTY CIVIL RIGHTS PRISONER PETITIONS ’ 790 Other Labor Litigation FEDERAL TAX SUITS ’ 893 Environmental Matters
’ 210 Land Condemnation ’ 440 Other Civil Rights Habeas Corpus: ’ 791 Employee Retirement ’ 870 Taxes (U.S. Plaintiff ’ 895 Freedom of Information
’ 220 Foreclosure ’ 441 Voting ’ 463 Alien Detainee Income Security Act or Defendant) Act
’ 230 Rent Lease & Ejectment ’ 442 Employment ’ 510 Motions to Vacate ’ 871 IRS—Third Party ’ 896 Arbitration
’ 240 Torts to Land ’ 443 Housing/ Sentence 26 USC 7609 ’ 899 Administrative Procedure
’ 245 Tort Product Liability Accommodations ’ 530 General Act/Review or Appeal of
’ 290 All Other Real Property ’ 445 Amer. w/Disabilities - ’ 535 Death Penalty IMMIGRATION Agency Decision
Employment Other: ’ 462 Naturalization Application ’ 950 Constitutionality of
’ 446 Amer. w/Disabilities - ’ 540 Mandamus & Other ’ 465 Other Immigration State Statutes
Other ’ 550 Civil Rights Actions
’ 448 Education ’ 555 Prison Condition
’ 560 Civil Detainee -
Conditions of
Confinement
V. ORIGIN (Place an “X” in One Box Only)
’ 1 Original ’ 2 Removed from ’ 3 Remanded from ’ 4 Reinstated or ’ 5 Transferred from ’ 6 Multidistrict ’ 8 Multidistrict
Proceeding State Court Appellate Court Reopened Another District Litigation - Litigation -
(specify) Transfer Direct File
Cite the U.S. Civil Statute under which you are filing (Do not cite jurisdictional statutes unless diversity):
35 U.S.C. Sections 163 and 271
VI. CAUSE OF ACTION Brief description of cause:
Patent Infringement
VII. REQUESTED IN ’ CHECK IF THIS IS A CLASS ACTION DEMAND $ CHECK YES only if demanded in complaint:
COMPLAINT: UNDER RULE 23, F.R.Cv.P. JURY DEMAND: ’ Yes ’ No
VIII. RELATED CASE(S)
(See instructions):
IF ANY JUDGE DOCKET NUMBER
DATE SIGNATURE OF ATTORNEY OF RECORD
01/22/2020 s/ Stuart R. Dunwoody
FOR OFFICE USE ONLY

RECEIPT # AMOUNT APPLYING IFP JUDGE MAG. JUDGE


Case 2:20-cv-00038-SMJ ECF No. 1-3 filed 01/22/20 PageID.18 Page 1 of 2

AO 440 (Rev. 06/12) Summons in a Civil Action

UNITED STATES DISTRICT COURT


for the
Eastern District
__________ DistrictofofWashington
__________

)
)
WASHINGTON STATE UNIVERSITY )
)
Plaintiff(s) )
)
v. Civil Action No. 2:20-cv-00038
)
)
PRO ORCHARD MANAGEMENT, LLC and
)
APPLE KING, LLC
)
)
Defendant(s) )

SUMMONS IN A CIVIL ACTION

To: (Defendant’s name and address) PRO ORCHARD MANAGEMENT, LLC


c/o Raymond Keller, its Registered Agent
3581 Mapleway Road
Yakima, Washington 98908-9645

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 plaintiff’s attorney,
whose name and address are:
Stuart Dunwoody
Davis Wright Tremaine LLP
920 Fifth Avenue, Suite 3300
Seattle, WA 98104-1610

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 SEAN F. McAVOY, Clerk


Case 2:20-cv-00038-SMJ ECF No. 1-3 filed 01/22/20 PageID.19 Page 2 of 2

AO 440 (Rev. 06/12) Summons in a Civil Action (Page 2)

Civil Action No. 2:20-cv-00038

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 individual’s 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 individual’s 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 $ 0.00 .

I declare under penalty of perjury that this information is true.

Date Server’s signature

Printed name and title

Server’s address

Additional information regarding attempted service, etc:


Case 2:20-cv-00038-SMJ ECF No. 1-4 filed 01/22/20 PageID.20 Page 1 of 2

AO 440 (Rev. 06/12) Summons in a Civil Action

UNITED STATES DISTRICT COURT


for the
Eastern District
__________ DistrictofofWashington
__________

)
)
WASHINGTON STATE UNIVERSITY )
)
Plaintiff(s) )
)
v. Civil Action No. 2:20-cv-00038
)
)
PRO ORCHARD MANAGEMENT, LLC and
)
APPLE KING, LLC
)
)
Defendant(s) )

SUMMONS IN A CIVIL ACTION

To: (Defendant’s name and address)


APPLE KING, LLC
c/o Ramond Keller, its Registered Agent
3581 Mapleway Road
Yakima, Washington 98904

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 plaintiff’s attorney,
whose name and address are:
Stuart Dunwoody
Davis Wright Tremaine LLP
920 Fifth Avenue, Suite 3300
Seattle, WA 98104-1610

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 SEAN F. McAVOY, Clerk


Case 2:20-cv-00038-SMJ ECF No. 1-4 filed 01/22/20 PageID.21 Page 2 of 2

AO 440 (Rev. 06/12) Summons in a Civil Action (Page 2)

Civil Action No. 2:20-cv-00038

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 individual’s 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 individual’s 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 $ 0.00 .

I declare under penalty of perjury that this information is true.

Date Server’s signature

Printed name and title

Server’s address

Additional information regarding attempted service, etc:

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