Fill and Sign the For Dissolution of Marriage Cases Only Form

Page 1 of 3 Form TCM-TR-4.1-2 Revised by State Court Administration 09/2014 STATE OF INDIANA ) IN THE SUPERIOR / CIRCUIT COURT 1 ) SS: CIVIL DIVISION, ROOM 2 COUNTY OF ) CASE NO. 3 IN RE THE MARRIAGE OF: 4 5 Petitioner, 6 and 7 8 Respondent. 9 SUMMONS 10 [For Dissolution of Marriage Cases Only ] 11 The State of Indiana to Respondent: 12 13 14 15 You have been sued by your spouse for dissolution of your marriage. The case is pending in the 16 Court named above. 17 In order to participate in the proceedings, you must enter a written appearance in person or by 18 your attorney. In the event you do not enter a written appearance within sixty (60) days of the date 19 hereof, your marriage can be dissolved by Decree of the Court by default. In the event a Decree is 20 entered by default, it may contain a judgment against you and provisions regarding the custody of your 21 child(ren), support for your child(ren), parenting time with your child(ren), distribution of assets, and 22 payment of debts. The Decree may also require you to take actions or refrain from actions in order to 23 carry out the terms of the Court’s Decree. If you do not enter a written appearance, you will receive no 24 further notice of these proceedings. 25 If you wish to countersue, you must do so by written petition filed with the Clerk’s Office listed 26 below not more than sixty (60) days from the date below. 27 Dated: _________________ _____________________________________ 28 Clerk, __________________ County 29 30 Page 2 of 3 Form TCM-TR-4.1-2 Revised by State Court Administration 09/2014 The following manner of Service of Summons is hereby designated: 31 Registered / Certified Mail to be sent by the Clerk 32 Service by Sheriff on Individual at address shown above 33 Service by Sheriff at place of employment, (name and address of spouse’s employer): 34 ________________________________________________________________________ 35 SHERIFF’S RETURN OF SERVICE OF SUMMONS 36 I hereby certify that I have served this summons on the _____ day of _________________, 20____: 37 By delivering a copy of the Summons and a copy of the complaint to the Respondent identified 38 on the first page of Summons. 39 By leaving a copy of the Summons and a copy of the complaint at 40 _______________________________________, which is the dwelling place or usual place of 41 abode of and by mailing a copy of the Summons to the Respondent at the above address. 42 Other Service or Remarks: _________________________________________ 43 _________________________ _____________________________________ 44 Sheriff’s Costs Sheriff 45 By: __________________________________ 46 Deputy 47 CLERK’S CERTIFICATE OF MAILING 48 I hereby certify that on the ______ day of ________________, 20___, I mailed a copy of this 49 Summons and a copy of the Petition to the Respondent identified on the first page of the Summons by 50 (registered or certified mail), [ ] requesting a return receipt, at the address provided by the Petitioner. 51 Dated: _________________ _____________________________________ 52 Clerk, __________________ County 53 By: __________________________________ 54 Deputy 55 56 Page 3 of 3 Form TCM-TR-4.1-2 Revised by State Court Administration 09/2014 RETURN ON SERVICE OF SUMMONS BY MAIL 57 I hereby certify that the attached receipt was received by me showing that the Summons and a 58 copy of the Complaint mailed to the Respondent identified on the first page of this Summons 59 was accepted by the Respondent on the _______ day of __________________, 20____. 60 I hereby certify that the attached return receipt was received by me showing that the Summons 61 and a copy of the Complaint was returned not accepted on the ______ day of 62 __________________, 20____. 63 I hereby certify that the attached return receipt was received by me showing that the Summons 64 and a copy of the Complaint mailed to the Respondent identified on the first page of this 65 Summons was accepted by ____________________ on behalf of the Respondent on the _____ 66 day of ______________, 20____. 67 _____________________________________ 68 Clerk, __________________ County 69 By: __________________________________ 70 Deputy 71