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Recipient signed this acknowledgment on specify date TYPE OR PRINT NAME OF PERSON ACKNOWLEDGING RECEIPT SIGNATURE OF PERSON ACKNOWLEDGING RECEIPT Page 1 of 1 Form Approved for Optional Use Judicial Council of California FL-117 Rev. January 1 2015 For your protection and privacy please press the Clear This Form button after you have printed the form. Family Law Print this form Save this form Code of Civil Procedure 415. FL-117 ATTORNEY OR PARTY WITHOUT ATTORNEY Name State Bar number and address TELEPHONE NO. FOR COURT USE ONLY FAX NO. E-MAIL ADDRESS ATTORNEY FOR Name SUPERIOR COURT OF CALIFORNIA COUNTY OF STREET ADDRESS CITY AND ZIP CODE BRANCH NAME PETITIONER RESPONDENT CASE NUMBER NOTICE AND ACKNOWLEDGMENT OF RECEIPT Sender completes items 1 through 4 and signs before mailing. Recipient completes items 5 and 6 signs then returns 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 you return this form to the sender service of a summons is deemed complete on the date you sign the acknowledgment of receipt below. 2. Date of mailing specify SIGNATURE OF SENDER MUST NOT BE A PARTY IN THIS CASE AND MUST BE 18 YEARS OR OLDER TYPE OR PRINT SENDER S NAME ACKNOWLEDGMENT OF RECEIPT I agree I received the following a. Family Law Petition Marriage/Domestic Partnership form FL-100 Summons form FL-110 and blank Response Marriage/Domestic Partnership form FL-120 b. E-MAIL ADDRESS ATTORNEY FOR Name SUPERIOR COURT OF CALIFORNIA COUNTY OF STREET ADDRESS CITY AND ZIP CODE BRANCH NAME PETITIONER RESPONDENT CASE NUMBER NOTICE AND ACKNOWLEDGMENT OF RECEIPT Sender completes items 1 through 4 and signs before mailing. Recipient completes items 5 and 6 signs then returns 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 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. 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. 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 c* 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 d.

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