STATE OF MAINE DISTRICT COURT Location Docket No. Judgment Creditor/Plaintiff v. Judgment Debtor/Defendant To: You have been served with a Statement of Claim, which means that you are being sued in Small Claims Court. You have been served with a Notice of Disclosure Hearing which means that you must go to court for a disclosure hearing on the date and time stated in the notice. Please sign the acknowledgment below and return this form in the enclosed stamped envelope so that it will be received by the sender within 20 days. (You may keep one copy of this form for your records.) If you do not sign and mail this form, it will be necessary to serve you by another method. The other method is more expensive and could cost $25.00 or more. This cost will be charged to you unless you win the small claims case. If you sign and mail this form, you will not be charged for service costs. It is to your advantage to sign below and mail one copy of this form in the enclosed envelope. ****************************************************************************** ACKNOWLEDGMENT OF RECEIPT OF NOTICE OF SERVICE I acknowledge that I received a copy of the Statement of Claim or Notice of Disclosure Hearing in the above-captioned matter. To avoid judgment by default in a Small Claims case, defendant must appear at the hearing. Defendant must also notify the clerk of court of any change of address so that defendant may receive notice of the hearing. Failure to attend the hearing may result in Default Judgment against the defendant or, in the case of a Disclosure, a Civil Order for Arrest of defendant. Date: NOTICE OF SERVICE OF STATEMENT OF CLAIM DISCLOSURE HEARING M.R.S.C.P. 4 Signature Printed name of person accepting service If the person signing this form is accepting service in a representative capacity, please state title and authority: SC-005, Rev. 06/14 Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com