IN THE CIRCUIT COURT FOR
                                       COUNTY,                                       (STATE)

TO:                                             , above-named Respondent.
          The enclosed Summons and Petition are served upon you by certified or registered mail pursuant to the Rules of Court.
          You must acknowledge part of this form and return one copy of the completed form to sender within 20 days.
          Signing this Acknowledgment of Receipt is only an admission that you have received the Summons and Petition and does not waive any other defenses.
          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 20 days, you (or the party on whose behalf you are being served) may be required to pay any expenses incurred in serving a Summons and Petition in any 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 Petition within 30 days. If you fail to do so, judgment by default will be taken against you for the relief demanded in the Petition.

          I declare, under penalty of perjury, that this Notice and Acknowledgment  of Receipt of Summons and Petition was mailed on                                         ,          .

ACKNOWLEDGMENT OF RECEIPT OF SUMMONS AND PETITION

          I,                                         (Respondent), declare, under penalty of perjury, that I received a copy of the Summons and Petition in the above-captioned matter at                                                                                 (Address).