Form CA 1-A: Notice and Acknowledgment for Service by Mail SUPERIOR COURT OF THE DISTRICT OF COLUMBIA CIVIL DIVISION ______________________________ Plaintiff(s) Case No: ______________________ v. ______________________________ Defendant(s) NOTICE To (insert name and address of the party to be served): ________________________________ ________________________________ ________________________________ ________________________________ The enclosed summons, complaint and initial order are served pursuant to Rule 4(c)(4) of the Superior Court Rules of Civil Procedure. You must sign and date the Acknowledgement (below). If you are served on behalf of a corporation, unincorporated association (including a partnership), or other entity, you must indicate next to 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 next to your signature your authority. If you do not complete and return the form to the sender within twenty (20) days after it has been mailed, you (or the other party on whose behalf you are being served) may be required to pay any expenses incurred in serving a summons, complaint and initial order in any other manner permitted by law. If you do complete and return this form, you (or the other party on whose behalf you are being served) must answer the complaint within twenty (20) days after you have signed, dated and returned the form. If you fail to do so, judgment by default may be entered against you for the relief demanded in the complaint. This Notice and Acknowledgment of Receipt of Summons, Complaint and Initial Order was mailed on (insert date): __________________. ________________________________ Signature ________________________________ Date of Signature ACKNOWLEDGMENT OF RECEIPT OF SUMMONS, COMPLAINT, AND INITIAL ORDER I (print name) ______________________________ received a copy of the summons, complaint and initial order in the above captioned matter at (insert address): ________________________________ ________________________________ ________________________________ _____________________________ Signature Para pedir una traducción, llame al (202) 879-4828 Để có một bài dịch, hãy gọi (202) 879-4828 _____________________________ _____________________________ Relationship to Defendant/Authority Date of Signature to Receive Service 如需翻译,请打电话 (202) 879-4828 የAማርኛ ትርጉም ለማግኘት (202) 879-4828 ይደውሉ Veuillez appeler au (202) 879-4828 pour une traduction 번역을 원하시면, (202) 879-4828 로 전화주십시요 American LegalNet, Inc. www.FormsWorkFlow.com