Summons For Dissolution Of Marriage Or Legal Separation Page 4
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4District Court ___________________________ County, Colorado
Court Address:
In re the Marriage of:
COURT USE ONLY
Petitioner: ______________________________________
Case Number:
and
Division
Courtroom
Respondent:____________________________________
RETURN OF SERVICE
I declare under oath that I am 18 years or older and not a party to the action and that I served this Summons, a copy of the
Petition, and if applicable the
Case Management Order,
Notice of Initial Status Conference, and
Other (Please
identify): _________________________________________ in this case on the Respondent in _________________ (County)
____________________ (State) on __________________ (date) __________ (time) at the following location:
____________________________________________________________________________________________________
By (Check one):
(print name of person served).
By handing it to a person identified to me as the Respondent:
By leaving it with _________________________________________ (Type or write name legibly), who is designated to
receive
service
for
the
Respondent
because
of
the
following
relationship
with
the
Respondent:
___________________________________________________ as provided for in C.R.C.P. 4(e).
I attempted to serve the Respondent on _______ occasions but have not been able to locate the Respondent. Return to
the Petitioner is made on ___________________ (date).
I attempted to leave it with Respondent who refused service.
Private process server
___________________________________
Sheriff, _________________________County
Signature of Process Server
Fee $ ____________ Mileage $ ________
___________________________________
Name (Print or type)
Subscribed and affirmed, or sworn to before me in the County of ______________________, State of
________________,
this ___________ day of _______________, 20 _______.
My Commission Expires: ________________________
___________________________________
Notary Public/Clerk
Page 4 of 4
JDF 1102
2-12
SUMMONS FOR DISSOLUTION OF MARRIAGE OR LEGAL SEPARATION
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