Fill and Sign the Summons and Complaint Form 481368097

IN THE CIRCUIT COURT OF_________ COUNTY, ____________ PLAINTIFF ) ) ) ) NO. V. ) ) NAME OF DEFENDANT ) ) NOTICE TO: __________ __________ __________ The enclosed summons and complaint are served pursuant to Rule 4(c)(3) of the __________ Rules of Civil Procedure. You must sign and date the acknowledgment 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 fai l to do so, judgment by default will be taken against you for the relief demanded in the complaint. I declare that this Notice and Acknowledgment or Receipt of Summons and Complaint was mailed on __________, ______. ________________________________ __________, ATTORNEY FOR PLAINTIFF THIS ACKNOWLEDGMENT 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 __________. _____________________________ (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 Acknowledgment of Recei pt of Summons and Complaint are true and correct as therein stated. Affirmed and subscribed before me this _______ day of ______________________, 20___. ____________________________ NOTARY PUBLIC MY COMMISSION EXPIRES: _______________________