CO URT O F CO M M O N PLEAS DI VI SI O N O F DO M ESTI C RELATI O N S CLERM O N T CO UN TY, O HI O CASE NO. Petitioner AND APPEARANCE AND WAIVER OF SUMMONS Petitioner The undersigned hereby acknowledges receipt of a copy of the Petition for Dissolution and enters his/her appearance in the above-entitled action expressly waiving the issuance and service of summons. Date Petitioner Petitioner 6/2011 Form DR-701 American LegalNet, Inc. www.FormsWorkFlow.com