STATE OF INDIANA ) IN THE (Select One) ) SS: ) CASE NO. COUNTY OF (Select One) SUPERIOR/CIRCUIT COURT IN RE THE MARRIAGE OF: Petitioner, V. Respondent. SUMMONS [For Dissolution of Marriage Cases Only] TO RESPONDENT: _______________________________________________ _______________________________________________ _______________________________________________ 1. 2. 3. 4. Dated: You are hereby notified that you have been sued by the Petitioner for Dissolution of Marriage in the Court indicated above. If this summons is accompanied by an Notice to Appear, you should appear in Court on the date and time stated in the Order to Appear. If you do not appear, evidence may be heard in your absence and a determination made by the Court. If a Temporary Restraining Order is attached, it is effective immediately upon your receipt or knowledge of the Order. If you wish to retain an attorney to represent you in this matter, it is advisable to do so before the date stated in the Notice to Appear. If you take no action in this case after the receipt of this summons, the Court can grant a Dissolution of Marriage or make a determination regarding any of the following: paternity, child custody, child support, maintenance, parenting time, property division (real or personal) and any other distribution of assets and debts. _________________ __________________________________ Clerk, (Select One) __________________ County Court name: ________________________________________ Court address: ________________________________________ Court phone : ________________________________________ The following manner of Service of Summons is hereby designated: Registered / Certified Mail to be sent by the Clerk Service by Sheriff on Individual at address shown above Service by Sheriff at place of employment, (name and address of spouse’s employer): ________________________________________________________________________ Form #PS-31152-1 Approved by State Court Administration 05/09 Page 12 of 13 American LegalNet, Inc. www.FormsWorkFlow.com SHERIFF’S RETURN OF SERVICE OF SUMMONS I hereby certify that I have served this summons on the _____ day of _________________, 20____: 1. By delivering a copy of the Summons and a copy of the complaint to the Respondent identified on the first page of Summons. 2. By leaving a copy of the Summons and a copy of the complaint at _______________________________________, which is the dwelling place or usual place of abode of and by mailing a copy of the Summons to the Respondent at the above address. 3. Other Service or Remarks: _________________________ Sheriff’s Costs _________________________________________ _____________________________________ Sheriff By: _______________________________ Deputy CLERK’S CERTIFICATE OF MAILING I hereby certify that on the ______ day of ________________, 20___, I mailed a copy of this Summons and a copy of the Complaint to the Respondent identified on the first page of the Summons by __________ mail, requesting a return receipt, at the address provided by the Petitioner. Dated: ______________, 20____ _____________________________ Clerk, __________________ County By: _________________________ Deputy RETURN ON SERVICE OF SUMMONS BY MAIL I hereby certify that the attached receipt was received by me showing that the Summons and a copy of the Complaint mailed to the Respondent identified on the 1st page of this Summons was accepted by the Respondent on the _______ day of __________________, 20____. I hereby certify 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 certify that the attached return receipt was received by me showing that the Summons and a copy of the Complaint mailed to the Respondent identified on the 1st page of this Summons was accepted by ____________________ on behalf of the Respondent on the _____ day of ______________, 20____. _____________________________ Clerk, __________________ County By: _________________________ Deputy Form #PS-31152-1 Approved by State Court Administration 05/09 Page 13 of 13 American LegalNet, Inc. www.FormsWorkFlow.com