JDF 1222 (b) R 2/1 9 RETURN OF SERVICE District Court County, Colorado Court Address: In re: The Marriage of: The Civil Union of: Parental Responsibilities concerning: Petitioner: and Co - Petitioner/ Respondent: COURT USE ONLY Case Number: Division Courtroom RETURN OF SERVICE I declare under oath that I am 18 years or older and not a party to the action and that I served this Summons, a copy of the Petition, and if applicable , the Case Management Order, Notice of Initial Status Conference, and Other (Please identify): in this case on the Respondent in (County) (State) on (date) (time) at the following location: By (Check one): By handing it to a person identified to me as the Respondent: (print name of person served) . By leaving it with (Type or write name legibly), who is designated to receive service for the Respondent because of the following relat ionship with the Respondent: as provided for in C.R.C.P. 4(e). I attempted to serve the Respondent on occasions but have not been able to locate the Respondent. Return to the Petitioner is made on (date). I attempted to leave it with Respondent who refused service. By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form. By checking this box, I am acknowledging that I have made a change to the original content of this form. VERIFICATION AND ACKNOWLEDGEMENT I swear/affirm under oath that the statements set forth therein are true and correct to the best of my knowledge. Private process server Sheriff, County Signature of Process Serer Fee $ Mileage $ Name (Print or type) Subscribed and affirmed, or sworn to before me in the County of , State of , this day of , 20 . My Commission Expires: Notary Public/Clerk American LegalNet, Inc. www.FormsWorkFlow.com