Fill and Sign the Served Complaint Form

IN THE       COURT OF       COUNTY, MISSISSIPPI       PLAINTIFF VS. CAUSE NO.             DEFENDANTS NOTICE TO:                   The enclosed summons and complaint are served pursuant to Rule 4(c)(3) of the Mississippi Rules of Civil Procedure. You must sign and date the acknowledgement at the bottom of this page. If you are served on behalf of a corporation, unincorporated association, (including 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 20 days of the date of mailing shown below, you (or the party on whose behalf you are being served) may be required to pay any expenses incurred in serving a summons and complaint. If you do not complete and return this form you (or the party on whose behalf you are being served) must respond to the complaint within 30 days of receipt of this notice. If you fail to do so, judgment by default will be taken against you for the relief demanded in the complaint. I declare that this Notice and Acknowledgement or Receipt of Summons and Complaint was mailed on       ,       . Respectfully submitted this the       day of       , 20       . _______________________________________       Attorney for       Of Counsel:                         Telephone:       MSB #       Attorney for       THIS ACKNOWLEDGEMENT OF RECEIPT OF SUMMONS AND COMPLAINT MUST BE COMPLETED I acknowledge that I have received a copy of the summons and of the complaint in the above-captioned matter in the State of Mississippi. _____________________________ (Signature) _____________________________ (Relationship to Entity / Authority to Receive Service of Process) _____________________________ (Date of Signature) STATE OF       COUNTY OF       Personally appeared before me, the undersigned authority in and for the State and County aforesaid, the above named       , who solemnly and truly declared and affirmed before me that the matters and facts set forth in the foregoing Acknowledgement of Receipt of Summons and Complaint are true and correct as therein stated. Affirmed and subscribed before me this       day of       ,       . ____________________________ NOTARY PUBLIC MY COMMISSION EXPIRES: _______________________