In the
CIRCUIT COURT
┌
┐
For File Stamp Only
Of St. Louis County, Missouri
_________________________
__________________________________________
Date
Plaintiff/Petitioner
_________________________
Case Number
vs.
_________________________
Division
__________________________________________
Defendant/Respondent
└
┘
REQUEST FOR APPOINTMENT OF PROCESS SERVER
Comes now Plaintiff by and through Counsel and hereby moves, pursuant
Requesting Party
to Local Rule 28, and at his/her/its own risk requests the appointment of the Circuit Clerk of
Lawrence G Roth, Marybeth Rice, Pat Medley, Mark Wilcox, Richard Langdon, Kathleen Langdon, Kim Rice
Name of Process Server
Address or in the Alternative
Tel e phone
220 W Lockwood, Suite 104, St. Louis, Mo 63119
Name of Process Server
Address or in the Alternative
Tel e phone
Natural person(s) of lawful age to serve the summons and petition in this cause on the below
named parties. This appointment as special process server does not include the authorization
to carry a concealed weapon in the performance thereof.
SERVE:
SERVE:
____________________________________________
____________________________________________
Name
Name
____________________________________________
____________________________________________
Address
Address
____________________________________________
____________________________________________
City/State/Zip
City/State/Zip
SERVE:
SERVE:
____________________________________________
____________________________________________
Name
Name
____________________________________________
____________________________________________
Address
Address
____________________________________________
____________________________________________
City/State/Zip
City/State/Zip
Appointed as requested:
JOAN M. GILMER, Circuit Clerk
___________________________________________
Attorney/Plaintiff/Petitioner
___________________________________________
By
Bar No.
________________________________________
___________________________________________
Deputy Clerk
Address
___________________________________________
___________________________________________
Phone No.
Fax No.
Date
WHITE – File
YELLOW-Special Process Server
PINK - Attorney/Petitioner
CCADM62
Rev. 03/06
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