Fill and Sign the Acknowledgment Receipt Form

IN THE CIRCUIT COURT OF _______________ COUNTY, ILLINOIS _______________ JUDICIAL CIRCUIT _____________________________________ Plaintiff No. _________________________ _____________________________________ Defendant NOTICE AND ACKNOWLEDGMENT OF RECEIPT OF SUMMONS AND COMPLAINT NOTICE To: (Insert the name and address of the person to be served) The enclosed summons and complaint are served pursuant to section 2--213 of the Code of Civil Procedure. You must complete the acknowledgment part of this form and return one copy of the completed form to the sender within _____ * days. You must sign and date the acknowledgment. If you are served on behalf of a corporation, unincorporated association (including a partnership), or other entity, you must indicate under your signature your relationship to that entity. If you are served on behalf of another person and you are authorized to receive process, you must indicate under your signature your authority. If you do not complete and return the form to the sender within _____ * days, you (or the party on whose behalf you are being served) may be served a summons and complaint in any other manner permitted by law. If you do complete and return this form, you (or the party on whose behalf you are being served) must answer the complaint within _____ ** days. If you fail to do so, judgment by default will be taken against you for the relief demanded in the complaint. I declare, under penalty of perjury, that this notice and acknowledgment of receipt of summons and complaint will have been mailed on _________________________ . (Insert Date) Signature ______________________________ Date of Signature _______________________ - 1 - ACKNOWLEDGMENT OF RECEIPT OF SUMMONS AND COMPLAINT I declare, under penalty of perjury, that I received a copy of the summons and of the complaint in the above-captioned matter at: ________________________________________________ _____________________________________________________________(inset address). PRINT or TYPE Name _____________________________________. Relationship to Entity/Authority to Receive Service of Process : _____________________________________________________ (Not Applicable if you are the named Defendant or Respondent) Signature _____________________________________ Date of Signature __________________________ * (To be completed by the person sending the notice.) Date for return of waiver must be at least 30 days from the date on which the request is sent, or 60 days if the defendant is addressed outside the United States. ** (To be completed by the person sending the notice.) Date for answering complaint must be at least 60 days from the date on which the request is sent, or 90 days if the defendant is addressed outside the United States. - 2 -