SHERIFF'S OFFICE USE ONLY DIVISION NAME & NO. AMOUNT $ SERVICE CODE RECEIPT NO. HEARING DATE COURT CODE (NUMERIC-ALPHA) CASE NO. (NUMERIC) CHG. ACCT. NO. RETURN DATE FORWARD SERVICE TO: DIVISION NAME AND NUMBER LITIGANT - COMPLETE THIS PORTION DIVISION NAME CASE NO. Plft. Deft. YOU ARE HEREBY INSTRUCTED TO EXECUTE THE ACCOMPANYING PROCESS FEES SERVED: TITLE: LEFT WITH: TITLE: HOME ADDRESS PERSONAL SERVICE BOXES CHECKED ON SUMMONS: $ AS FOLLOWS: LEVY DATE BUSINESS ADDRESS SUBSTITUTE SERVICE AS AN INDIVIDUAL DEFENDANT FICTITIOUS NAME ON BEHALF OF CORPORATION DEFUNCT CORPORATION ASSOC. / PARTNERSHIP OTHER BY PERSONAL DELIVERY ON: COPY MAILED MINOR CONSERVATEE INDIVIDUAL ACCEPT $ PLUS COST OF THE LEVY TO SATISFY THIS CASE. MALE AGE HAIR FEMALE M.A. WT. YES HT. NO DATE Signature of Attorney or Litigant Date TIME AM PM AM PM AM PM AM PM # SERVED NOTICE ALL COMMUNICATIONS, REFUNDS, AND COLLECTIONS WILL BE MADE TO THE NAME AND ADDRESS LISTED BELOW. X - NOT FOUND TELEPHONE NO.: CHARGE TO ACCOUNT NO.: Y - NO SERVICE Z - CANCELLED TYPE OR PRINT NAME ADDRESS CITY 76S357 - PS 8-84 DEPUTY NAME AND NUMBER STATE ZIP CODE DOC. NO. SERVICE TICKET American LegalNet, Inc. www.USCourtForms.com