SUPERIOR COURT OF THE DISTRICT OF COLUMBIA PROBATE DIVISION _________________________________ Plaintiff vs. _________________________________ Defendant(s) _____ LIT _____ (linked to __________) (Estate of: __________________) NOTICE AND ACKNOWLEDGMENT OF RECEIPT OF SUMMONS, COMPLAINT AND INITIAL ORDER TO:_______________________________________________ ADDRESS:_________________________________________ __________________________________________________ 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 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 your authority under your signature. If you do not complete and return the form to the sender within twenty (20) days after it has been mailed, you (or the 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 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 taken against you or the relief demanded in the complaint may be granted. This Notice and Acknowledgment of Receipt of Summons, Complaint and Initial Order was mailed on _________________________________ (insert date mailed). ___________________________________ Signature of sender __________________ Date signed Acknowledgment of Receipt of Summons, Complaint and Initial Order I received a summons, copy of the complaint and initial order in the above captioned matter at _________________________________________________________________________________. _________________________ Signature ______________________________ Relationship to defendant/ Authority to receive service of process ____________ Date signed August 2010 � 1212.10.v1 American LegalNet, Inc. www.FormsWorkFlow.com