SUMMONS

STATE OF INDIANA IN THE nCounty where court is::LIKE THISo nType of

court::LIKE THISo COURT nIF Does this court have a
division number?onCourt's division numberonEND IFo

SS: nYear:1990o TERM

COUNTY OF nCounty where court is::LIKE THISo

CAUSE NO.: nCause numbero

In Re the legal separation of:

n Petitioner's nameo ,
Petitioner,

and

n Respondent's nameo
Respondent

TO RESPONDENT:
nOpposing Party Nameo
nOpposing Party Addresso
nOpposing Party Cityo, nOpposing Party Stateo nOpposing Party Zipo

You are hereby notified that the person named as petitioner has filed a Petition for Legal Separation in the court indicated above. A copy of
this Petition for Legal Separation is attached to this summons. It also states the relief sought or the dem and m ade ag ainst you b y the petitione r.

An answer o r other app ropriate resp onse in w riting to the Pe tition for Legal Sep aration is no t required. H owever, if you fail to appea r for a
hearing a judgme nt by defau lt may be re ndered a gainst you for the relief dem anded by petitioner.

Dated: _________________
__________________________________________ (Seal )
Clerk of nCounty where court is: :LIKE T HIS o nType of court ::LIKE T HIS o Court
nIF Does this court ha ve a division n umbe r? onCour t's division n umb er:Ix onEND
IF o

The following manne r of service of summon s is hereby designated .: nHow to serve the op posing p arty o. nIF Are w e serving Respo ndent at his
employm ent? onRespondent's place of employment and add ress onEND IF o

__________________________
Samuel C. Hasler, 11971-48
Attorney for Petitioner
nMY ADDRESS1 o
Anderson, IN nMY ZIP CODE o
765-641-7906
 C LE RK' S CERTIFICATE OF MA IL ING

I hereby certify tha t on the __ _____ _____ _____ day of __ _____ _____ _____ , nYearo, I mailed a cop y of this summons and a copy of the Petition
for Legal Separation to the respondent, _________________, by _________________ mail, requesting a return receipt, at the address furnished
by the petition er.

__________________________________________________________________
Clerk of nCoun ty wher e cour t is::LIKE THIS o nType o f court::L IKE TH IS o Court nIF Does
this court ha ve a division n umbe r? onCour t's division numb er:Ix onEND IF oo
By _________________
Depu ty

Dated: _____ _____ _____ __, nYearo

RETU RN O N SER VICE OF S UMM ON S BY M AIL

I hereby certify tha t the attach ed return rec eipt was re ceived by m e showin g that:

_________________ (1) The summons and a copy of the Petition for Legal Separation mailed to respondent _________________ was accepted
by the respondent on _________________

__________________ (2) The attached return receipt was received by me showing that the summons and a copy of the Petition for Legal
Separation mailed to respondent _________________ was accepted by _________________ on b ehalf of said respondent on
_________________.

_________________ (3) The atta ched retu rn receipt was received by me showing that the summons and a copy of the Petition for Legal
Separation was returned not accepted on _________________.

_________________________________________________
Clerk of nCounty w here cou rt is::LIKE THIS o nType o f court::L IKE TH IS o Court nIF Does
this court ha ve a division n umbe r? onCour t's division numb er:Ix onEND IF o

S H E RIFF'S RETURN ON SERVICE OF SUMMON S

I hereby certify tha t I have served this summ ons on the _____ _____ _____ __ day o f _____ _____ _____ __, nYearo:

(1) By delivering a copy of the summons and a copy of the Petition for Legal Separation to the respondent, _________________.

(2) By leaving a copy of the summons and a copy of the Petition for Legal Separation at _________________, the dwelling place or
usual place of abode of the said respondent ______________________________________________

(3) ______________________________

_________________________________
Sheriff f nCoun ty wher e cour t is::LIKE THIS o County, Indiana
Clerk oof

By _________________________________________
Depu ty nIF
Are there support issues or related cases?onINSERT "Summons continuantion page.wpt"onEND IFo
nIF Do we need Notice of Hearing?onASSEMBLE "sep - Notice of Hearing .wpt"onEND IFo
nIF Do we need an Appearance?o
nASSEMBLE "sep - Appearance by Attorney for Initiating Party.wpt"onEND IFo