Fill and Sign the Summons Petition for Modification of Child Support and Judgment of Arrears and Confidential Form

Acknowledgement and Acceptance of Service July 2014 Page 1 of 2 STATE OF WYOMING ) IN THE DISTRICT COURT ) ss COUNTY OF ________________ ) _______________ JUDICIAL DISTRICT Petitioner:___________________________,) Civil Action Case No. __________ (Print name of person filing) ) ) vs. ) ) Respondent:_________________________ .) (Print name of other party) ACKNOWLEDGEMENT AND ACCEPTANCE OF SERVICE I, _______________________ _, hereby acknowledge receipt of a copy of the (Print Respondent’s Name) Summons, Petition for Modification of Child Support and Judgment of Arrears , and Confidential Statement of the Parties for Child Support Order , filed in this case. In accepting service of process, I retain all defenses or objections to the lawsuit or to the jurisdiction or venue of the court except for objections based on a defect in the Summons or in the service of the Summons. I understand that I must answer or otherwise plead within 20 days from this date (30 days if copies of the papers were received outside of Wyoming) and that if I fail to file an answer or other pleadings with the Clerk of this Court and serve the same upon the Petitioner in accordance with the Wyoming Rules of Civil Procedure within the time limits stated, I will be in default and Petitioner may be afforded the relief demanded in the Petition without a trial or other hearing. DATED this _________ day of __________________________, 20____. Respondent’s Signature Phone Number: Address: City/State/Zip Code: Subscribed and sworn to before me on this ________ day of ______________________, 20_____. WITNESS my hand and official seal. ____________________________________ Notarial Officer My Commission Expires: Acknowledgement and Acceptance of Service July 2014 Page 2 of 2 C E R T I F I C A T E O F S E R V I C E I certify that on (date) the original of this document w as filed with the Clerk of District Court; and, a true and accurate copy of this document was served on the other party by Hand Delivery OR Faxed to this number OR by placing it in the United States mail, postage pre-paid, and addressed to the following: (Print Other Party’s /Other Party’s Attorney’s Name and Address) TO: ______________________________________ ______________________________________ ______________________________________ Your signature Print name