Form 171-142 - Summons Form - Lake County, Illinois Page 2
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1
2SHERIFF’S FEES
( Service and return
$____________________
(
( Miles ______________ $____________________
(
( Total
$____________________
Sheriff of _________________________ County
I certify that I served this summons on defendants as follows:
(a)-(Individual defendants – Personal): (The officer or other person making service, shall (a)
identify as to sex, race and approximate age of the defendant with whom he left the summons, and (b)
state the place where (whenever possible in terms of an exact street address) and the date and time of
the day when the summons was left with the defendant).
(b)-(Individual defendants – Abode): By leaving a copy of the complaint at the usual place of each
individual defendant with a person of his family, of the age of 13 years or upwards, informing that person
of the contents of the summons. (The officer or other person making service, shall (a) identify as to sex,
race and approximate age of the person, other than the defendant, with whom he left the summons, and
(b) state the place where (whenever possible in terms of an exact street address) and the date and time
of day when the summons was left with such person).
and also by sending a copy of the summons and of the complaint in a sealed envelope with postage fully
prepaid, addressed to each individual defendant at his usual place of abode, as follows: Name of
defendant Mailing Address Date of mailing
(c)-(Corporate defendants): By leaving a copy and a copy of the complaint with the registered
agent, officer or agent of each defendant corporation, as follows: Defendant corporation Registered agent,
officer or agent Date of Service
(d)-(Other service):
Sheriff of ___________________ County
By: ______________________________
(Deputy)
Summons for Defendant:
____________________
was
served on or
left with:
Name/Description:
_________________________
Sex:
M
F
Race:
Approx. age with whom the summons was left with: __
years of age
Address/Place where summons was left:____________________________________________________
(Back)
171-142 Rev 9/10
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