CIRCUIT COURT FOR THE COUNTY OF CLAY, MISSOURI PROBATE DIVISION STATE OF MISSOURI SEVENTH JUDICIAL CIRCUIT DIVISION FOUR Case No. Matter of SUMMONS The State of Missouri to Respondent/Defendant: You are hereby summoned to appear before the above-named court and to file your pleading to the petition, copy of which is hereto, and to serve a copy of your pleading upon Attorney for Plaintiff towit: All within 30 days after service of this summons upon you, exclusive of the day of service. If you fail to do so, judgment by default will be taken against you for the relief demanded in the petition. (Seal) Dated_______________________ JOYCE GRAY, CLERK By Deputy Clerk Form 225 Revised 6/1/2007 Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com RETURN OF SERVICE OF SUMMONS I HEREBY CERTIFY THAT I HAVE SERVED THE ATTACHED SUMMONS: (1) By delivering, on the _____ day of ___________________, 20_____, a copy of the summons and a copy of the petition to the following named Respondent(s)/Defendant(s)_________________________________________________________________ at _____________________________________________________________________________ (2) By leaving, on the _____ day of __________________________, 20_____, for the following named Respondent(s)/Defendant(s)_________________________________________________________________ A copy of the summons and a copy of the petition at the respective dwelling place or usual place of abode of said defendant(s) at _____________________________________________________ with _______________________________________________________________________________, a person of his or her family over the age of 15 years: ) (3) By:________________________________________________________________ Sheriff’s Fees: Summons $ Non Est $ Mileage $ TOTAL $ Form 225 Revised 6/1/2007 Sheriff of ________________County, Missouri By:_________________________________ Deputy Sheriff Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com