Supreme Court Rules
Forms - Rules of Civil Procedure - Civil Procedure Forms
Publication / Adopted Date:
September 28, 1993
Notice and Acknowledgement for Service By Mail - Circuit Division Cases
Revised / Effective Date:
January 1, 1994
FORM NO. 4-B.
(CIRCUIT DIVISION CASES)
NOTICE AND ACKNOWLEDGMENT FOR SERVICE BY MAIL
CIRCUIT COURT FOR __________ COUNTY
Civil Action, File Number
TO: (Insert the name and address of the person to be served)
The enclosed summons and petition are served pursuant to Missouri
Supreme Court Rule 54.16
You may sign and date the acknowledgment part of this form and return one copy of the completed form to the sender within thirty days of __________________.
(insert date of mailing)
If you are served on behalf of a corporation, unincorporated association, including a partnership, or other entity, you must indicate under your signature your relationship to that entity. If you are served on behalf of another person and you are authorized to receive process, you must indicate under your signature your authority.
If you do not complete and return the form to the sender within thirty days, you or the party on whose behalf you are being served may be required to pay any expenses incurred in serving a summons and petition in any other manner permitted by law.
If you do complete and return this form, you or the party on whose behalf you are being served must answer the petition within thirty days of the date you sign the acknowledgment below. If you fail to do so, judgment by default may be taken against you for the relief demanded in the petition.
I DECLARE, UNDER PENALTY OF PERJURY, THAT THIS NOTICE WAS MAILED ON
(insert the date)
ACKNOWLEDGMENT OF RECEIPT OF SUMMONS AND PETITION
I declare, under penalty of filing a false affidavit, that I received a copy of the Summons and of the Petition in the above captioned matter.
Relationship to Entity/Authority
Receive Service of Process
(Adopted Sept. 28, 1993, eff. Jan. 1, 1994.)