CLERK’S CERTIFICATE OF MAILING I hereby certifiy that on the ____________ day of ___________________ , 20 ___ , I mailed a copy of this summons and a copy of the complaint to the respondent, _______________________________________________________ by ________________________mail, requesting a return receipt, at the address furnished by the petitioner. _________________________________________ Dated ______________________________________ , 20 _____ Clerk of the _______ Court of __________ County RETURN ON SERVICE OF SUMMONS BY MAIL I hereby certifiy that the attached return receipt was received by me showing that the summons and a copy of the complaint mailed to respondent _________________________________________________ was accepted by the respondent on the _________ day of __________________ , 20 ___ I hereby certifiy that the attached return receipt was received by me showing that the summons and a copy of the complaint was returned not accepted on the ___________ day of ________________________ , 20 ___ . I hereby certifiy that the attached return receipt was received by me showing that the summons and a copy of the complaint mailed to respondent ___________________________________________________________________________ was accepted by ______________________________________________________________ (Age) ___________ on behalf of said respondent on the ________________ day of __________________________________ , 20 ____ ____________________________________________ Clerk of the _______ Court of _____________ County SERVICE ACKNOWLEDGED A copy of the within summons and a copy of the complaint attached therein were received by me at_________________ _________________________ , this_______________ day of __________________________________ , 20 ____ . ___________________________________________ Signature