Free STATE OF WYOMING - Wyoming

STATE OF WYOMING COUNTY OF _______________

) ) ss )

IN THE DISTRICT COURT _______________ JUDICIAL DISTRICT ) ) ) ) ) ) ) Civil Action No. _______________

Petitioner, vs.

Respondent.

ACKNOWLEDGEMENT AND ACCEPTANCE OF SERVICE

I, ____________________________________________________, hereby
(Print Respondent's Name)

acknowledge receipt of a copy of the Petition to Modify Child Support and Judgment for Arrears filed in this case and the Summons issued by the clerk. I waive any requirement for other service of process (Rule 4(m)(2)(v), Wyoming Rules of Civil Procedure). I agree to answer or otherwise plead within 20 days from this date (30 days if copies of the papers were received outside of Wyoming). I understand that if I fail to file a response or other pleadings with the clerk of this court and serve the same upon the Petitioner in accordance with the Wyoming Rules of Civil Procedure within the time limits stated, I will be in default and Petitioner may be afforded the relief demanded in the Petition to Modify Child Support and Judgment for Arrears without a trial or other hearing. DATED this _________ day of __________________________, 20____.

Respondent's Signature Respondent's Phone Number: Respondent's Address: Respondent's City/State/Zip Code: Subscribed and sworn to before me on this ________ day of ____________________, 20_____. WITNESS my hand and notary seal. ____________________________________ Notary Public / Court Clerk My Commission Expires:
CSMod 8 Acknowledgement and Acceptance of Service Revised July 2006 Page 1 of 2

CERTIFICATE OF SERVICE I certify that on (date) the original of this document was

filed with the Clerk of District Court; and, a true and accurate copy of this document was served on the other party by OR Hand Delivery OR Faxed to this number

by placing it in the United States mail, postage pre-paid, and addressed to the following:

TO: ______________________________________ ______________________________________ ______________________________________

(Your signature)

Print name

CSMod 8 Acknowledgement and Acceptance of Service Revised July 2006 Page 2 of 2