This is a Illinois form that can be used for General within Local County, Cook.
Last updated: 7/12/2011
Print Form Clear Form Notice and Acknowledgment of Receipt of Summons and Complaint IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS (3/01/07) CCG 0063 _______________________________________________, v. Plaintiff(s) _______________________________________________, Defendant(s) } Case No. ________________________________ Defendant(s) Amount Claimed: $ _______________ NOTICE AND ACKNOWLEDGMENT OF RECEIPT OF SUMMONS AND COMPLAINT To: ________________________________________ Address: ____________________________________________ (Name) City: ________________________________________ State:______________________ Zip: ______________ The enclosed summons and complaint are served pursuant to section 2--213 of the Code of Civil Procedure. You must complete the acknowledgment part of this form and return one copy of the completed form to the sender within __________*days. You must sign and date the acknowledgment. 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 __________*days, you (or the party on whose behalf you are being served) may be served a summons and complaint 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 complaint within __________**days. If you fail to do so, judgment by default will be taken against you for the relief demanded in the complaint. I declare, under penalty of perjury, that this notice and acknowledgment of receipt of summons and complaint will have been mailed on _________________________, _________. Dated: ___________________________, _________ ________________________________________ Signature ACKNOWLEDGMENT OF RECEIPT OF SUMMONS AND COMPLAINT I declare, under penalty of perjury, that I received a copy of the summons and of the complaint in the above captioned matter at: (Please print or type) Name: __________________________________________ Address:_________________________________________ City/State/Zip: ___________________________________ Relationship to Entity /Authority to Receive Service of Process:_______________________________________________ (Not applicable if your are the named Defendant or Respondent.) Dated: ______________________________, ___________ ____________________________________________ Signature *(To be completed by the person sending the notice.) Date for return of waiver must be at least 30 days from the date on which the request is sent, or 60 days if the defendant is addressed outside the United States. **(To be completed by the person sending the notice.) Date for answering complaint must be at least 60 days from the date on which the request is sent, or 90 days if the defendant is addressed outside the United States. DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS
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