IN THE DISTRICT COURT OF COFFEY COUNTY, KANSAS LIMITED ACTIONS Plaintiff ) Plaintiff ) ) ) CASE NO. ____________________________ ) Defendant(s) ) vs. Defendant Defendant Address Defendant Address SUMMONS CHAPTER 61 SERVICE BY: (Type of Service) By: _____________________County Sheriff To the above-named defendant(s): You are hereby notified that a lawsuit commenced against you will be on this court’s docket at 10:00 o’clock A. .M., on the ____ day of __________________, ________, to be held at the District Court, Coffey County Courthourse, 110 S. Sixth, Burlington, Kansas. If you do not appear before this court or file an answer at such time, judgment by default will be taken against you for the relief demanded in the petition. If you intend to appear at such time and dispute the petition, you must file an answer with the clerk of this court within 10 days thereafter. If you are not represented by an attorney, the answer shall be signed by you. The answer shall state the following: (1) what the dispute is; (2) any affirmative defenses you have to the claim; (3) any claim you have against the plaintiff which arises out of the transaction or occurrence which is the subject of the plaintiff’s claim; and (4) your (or your attorney’s) current address, phone number, {fax phone number, and e-mail address}. You must also promptly send a copy of your answer to the plaintiff’s attorney or the plaintiff, if the plaintiff has no attorney. Reasonable accommodations will be provided in accordance with the Americans with Disabilities Act. TO THE SHERIFF OR PROCESS SERVER: This summons must be served and your return of service made promptly; in any event, your return is due no later than _____________________________, ___________. Dated: _________________________ ______________________________________________ Clerk’s signature Name of plaintiff or plaintiff’s attorney Address of plaintiff or plaintiff’s attorney Address of plaintiff or plaintiff’s attorney RETURN ON SERVICE OF SUMMONS I hereby certify that I have served this summons in the following manner: (1) PERSONAL SERVICE. By delivering a copy of such summons and petition to each of the following defendants on the dates indicated: _______________________________________________________________________________________________ (2) RESIDENTIAL SERVICE. By leaving a copy of such summons and petition at the usual place of residence of each of the following defendants with some person of suitable age and discretion residing therein on the dates indicated: ________________________________________________________________________________________________ (3) AGENT SERVICE. By delivering a copy of such summons and petition to each of the following agents authorized by appointment or by law to receive service of process on the dates indicated: ________________________________________________________________________________________________ (4) RESIDENCE SERVICE AND MAILING. By leaving a copy of such summons and petition at the usual place of residence of each of the following defendants and mailing by first-class mail on the dates indicated a notice that such copy has been so left: ________________________________________________________________________________________________ (5) SERVICE BY RETURN RECEIPT DELIVERY. By causing to be delivered on the ________ day of ________________________, ________, a copy of the summons and petition by return receipt delivery to each of the following defendants at the following address: ________________________________________________________________________________________________ with such delivery made by the following person or entity: ________________________________________________ Attached hereto is a copy of the return receipt evidencing such delivery. (6) RETURN RECEIPT DELIVERY REFUSED. By mailing on the _______ day of _______________________, __________, a copy of the summons and petition by first-class mail, postage prepaid, addressed to the following at the following address: ________________________________________________________________________________________________ (7) NO SERVICE. The following defendants were not served: ________________________________________________________________________________________________ Pursuant to K.S.A. 53-601, as amended, I declare under the penalty of perjury that the foregoing is true and correct. Executed on ____________________________, ______________. ________________________________________________ Signature & Title of Officer or Process Server American LegalNet, Inc. www.FormsWorkflow.com