IN THE SUPERIOR COURT OF FULTON COUNTY STATE OF GEORGIA FAMILY DIVISION Petitioner: and Respondent: , CIVIL ACTION FILE NO. ACKNOWLEDGMENT OF SERVICE AND WAIVER OF JURISDICTION The undersigned Respondent hereby acknowledges service of the Summons and Petition for , in the above-styled case, and states that s(he) has received copies of said Summons and Petition, and Respondent hereby waives any and all further notice, service, and issuance of process. (Check the box below if you are not a resident of Georgia.) WAIVER OF JURISDICTION ­ RESPONDENT'S AFFIDAVIT I, Petition for 1. ,am the named Respondent in the above-styled case, which is a After being duly sworn, I state the following: , and that I am a resident of County in the State of Petitioner is a resident of Fulton County, Georgia. My address is 2. I have been informed that I have a constitutional right to a trial by judge or jury in the state of my residence, and that I expressly waive my right to jurisdiction in the state of my residence, and consent to jurisdiction in the State of Georgia, Fulton County Superior Court. day of I This Respondent's Signature Address: Telephone: Sworn to and signed before me, this day of I NOTARY PUBLIC My commission expires: (Sign in front of the Notary) Acknowledgment of Service and Waiver of Jurisdiction Form © 2006 Fulton County Superior Court Family Division American LegalNet, Inc. www.FormsWorkflow.com