State of Minnesota County Judicial District: Court File Number: Case Type: District Court ___________________________________, Name of Petitioner (first, middle, last) ___________________________________, Name of Co- Petitioner, if any (first, middle, last) and ADMISSION OF SERVICE OF SUMMONS and PETITION FOR THIRD PARTY CUSTODY ___________________________________, Name of Respondent Parent A (first, middle, last) ___________________________________, Name of Respondent Parent B (first, middle, last) ___________________________________. Name of Respondent Guardian or Custodian (first, middle, last) My name is . I acknowledge that I have personally received a copy of the Summons and Petition for Third party Custody. I understand the following: 1. Signing this document starts the third party custody process; 2. Signing this document does not mean that I agree with everything in the Petition. It only means that I have received a copy of the Summons and Petition; 3. I have twenty (20) days from the date of signing this document to serve on the Petitioner an Answer to the Petition; 4. If I do not serve an Answer within twenty (20) days, I may be found in default and Petitioner may ask the Court for everything Petitioner has asked for in the Petition for Third Party Custody; 5. I do not have to sign this Admission. But if I do not sign, Petitioner can start the action by having the Summons and Petition personally served upon me and I may have to pay the cost of Petitioner doing this. CHC604 State ENG 5/17 www.mncourts.gov/forms Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com I declare under penalty of perjury that everything I have stated in this document is true and correct. Minn. Stat. § 358.116. Dated: Signature County and State where signed Name: Address: City/State/Zip: Telephone: E-mail address: CHC604 State ENG 5/17 www.mncourts.gov/forms Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com