Fl-117 - Notice And Acknowledgment Of Receipt
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1FL-117
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
FOR COURT USE ONLY
TELEPHONE NO.:
FAX NO. (Optional):
E–MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PETITIONER:
RESPONDENT:
OTHER:
CASE NUMBER:
NOTICE AND ACKNOWLEDGMENT OF RECEIPT
To
(name of individual being served):
NOTICE
The documents identified below are being served on you by mail with this acknowledgment form. You must personally sign, or a
person authorized by you must sign, this form to acknowledge receipt of the documents.
If the documents described below include a summons and you fail to complete and return this acknowledgment form to the
sender within 20 days of the date of mailing, you will be liable for the reasonable expenses incurred after that date in serving you
or attempting to serve you with these documents by any other methods permitted by law. If you return this form to the sender,
service of a summons is deemed complete on the date you sign the acknowledgment of receipt below. This is not an answer to
the action. If you do not agree with what is being requested, you must submit a completed Response form to the court within 30
calendar days.
Date of mailing:
(TYPE OR PRINT NAME)
(SIGNATURE OF SENDER—MUST NOT BE A PARTY IN THIS CASE
AND MUST BE 18 OR OLDER)
ACKNOWLEDGMENT OF RECEIPT
(To be completed by sender before mailing)
I agree I received the following:
a.
Family Law: Petition (form FL-100), Summons (form FL-110), and blank Response (form FL-120)
b.
Family Law—Domestic Partnership: Petition—Domestic Partnership (form FL-103), Summons (form FL-110), and
blank Response—Domestic Partnership (form FL-123)
c.
Uniform Parentage: Petition to Establish Parental Relationship (form FL-200), Summons (form FL-210), and blank
Response to Petition to Establish Parental Relationship (form FL-220)
d.
Custody and Support: Petition for Custody and Support of Minor Children (form FL-260), Summons (form FL-210),
and blank Response to Petition for Custody and Support of Minor Children (form FL-270)
e.
(1)
Completed and blank Declaration Under
(5)
Completed and blank Financial Statement
Uniform Child Custody Jurisdiction and
(Simplified) (form FL-155)
Enforcement Act (UCCJEA) (form FL-105)
(6)
Order to Show Cause (form FL-300), Application
Completed and blank Declaration of
for Order and Supporting Declaration (form
(2)
Disclosure (form FL-140)
FL-310), and blank Responsive Declaration to
Order to Show Cause or Notice of Motion (form
(3)
Completed and blank Schedule of Assets
FL-320)
and Debts (form FL-142)
(7)
Other (specify):
(4)
Completed and blank Income and
Expense Declaration (form FL-150)
(To be completed by recipient)
Date this acknowledgment is signed:
(SIGNATURE OF PERSON ACKNOWLEDGING RECEIPT)
(TYPE OR PRINT NAME)
Page 1 of 1
Code of Civil Procedure, §§ 415.30, 417.10
Form Approved for Optional Use
NOTICE AND ACKNOWLEDGMENT OF RECEIPT
Judicial Council of California
(Family Law)
FL-117 [Rev. January 1, 2005]
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