THIS IS AN ARBITRATION CASE STATE OF ILLINOIS COUNTY OF ROCK ISLAND IN THE CIRCUIT COURT OF THE 14TH JUDICIAL CIRCUIT _________________________________ PLAINTIFF CASE NO. __________ ________________________________ DEFENDANT SUMMONS To: Each Defendant You are hereby summoned and required to appear before this Court at the Rock Island County Courthouse, 210-15th Street, Rock Island, Illinois, on __________________________ at the hour of _________________.M. to answer the complaint of the plaintiff(s), a copy of which is attached hereto. IF YOU FAIL TO DO SO, A JUDGMENT BY DEFAULT MAY BE TAKEN AGAINST YOU FOR THE RELIEF ASKED IN THE COMPLAINT. RETURN: This summons may not be served later than three (3) days before the date of appearance. WITNESS: (SEAL OF COURT) DATED___________________________________________ __________________________________________________ CLERK OF THE FOURTEENTH JUDICIAL CIRCUIT NOTICE TO PLAINTIFF TAMMY R. WEIKERT, CLERK OF THE CIRCUIT COURT If you fail to appear on the date set for return shown above, the case will be dismissed for want of prosecution. IF THIS SUIT INVOLVES A CLAIM IN TORT, SUPREME COURT RULE 222 DISCLOSURE STATEMENT MUST BE ATTACHED TO THE COMPLAINT. Name____________________________ To the Officer: ARDC No.________________________ This summons must be returned by the officer or other Address: __________________________ person to whom it was given for service with City______________________________ endorsement of service and fees, if any, immediately after Phone_____________________________ service and not less than 3 days before the date of appearance. If service cannot be made, this summons shall be returned so endorsed. NOTICE TO PLAINTIFF OR PLAINTIFF'S ATTORNEY: When preparing the above Summons, you will insert a return date not less than 21 nor more than 40 days after the date of issuance. NOTE: The filing of an appearance or answer with the Circuit Court Clerk requires a statutory filing fee, payable at the time of filing. TAMMY R. WEIKERT, CLERK OF THE FOURTEENTH JUDICIAL CIRCUIT, ROCK ISLAND, ILLINOIS American LegalNet, Inc. www.FormsWorkFlow.com SHERIFF'S FEES Service and return.......................................................$______________ Miles.......................................................................$______________ Total........................................................................$_____________ ______________________________________ Sheriff of _____________________County I certify that I served this summons on defendants as follows: (Check appropriate box and complete information below) (a) - (Individual defendants-personal): By leaving a copy of the complaint with each individual defendant personally. (b) - (Individual defendants-abode): defendant with a person of his family, of the age of 13 years upwards, informing that person of B the contents and also by sending a copy of the summons is a sealed envelope with postage fully y prepaid, addressed to each individual defendant at his usual place of abode. l (c) ­ (Corporation defendants) e By leaving a copy and a copy of the complaint with the registered agent, officer or agent of each a defendant Corporation. v i (d) ­ (Other service): n g Name of Defendant________________________ Name of Defendant____________________ a Name of Person Summons given to_________________________ Name of Person Summons given to____________________ Sex________Race_____Approx Age______ Place of Service_______________________ ____________________________________ Date of Service___________Time________ Date of Mailing_______________________ ____________________________________ Sheriff of _____________________County By___________________________,Deputy c o Sex________Race________Approx. Age_______ p y Place of Service____________________________ a _________________________________________ n d Date of Service__________Time____________ a Date of Mailing____________________________ c o p y o f t h e c o m p l American LegalNet, Inc. www.FormsWorkFlow.com