Waiver of Service of Summons Request Form
Complete this form to request and acknowledge the waiver of formal service of summons in a legal case.
Requesting Party's Full Name
*
First Name
Last Name
Requesting Party's Email Address
*
example@example.com
Requesting Party's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Recipient's Full Name (Person Waiving Service)
*
First Name
Last Name
Recipient's Email Address
*
example@example.com
Recipient's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Case Number
*
Name of Court
*
Case Title/Parties Involved
*
Recipient's Role in Case
*
Please Select
Plaintiff
Defendant
Attorney
Other
Preferred Method of Receiving Summons
*
Email
Postal Mail
In Person
Other
Date of Request
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Additional Notes or Instructions (optional)
Signature of Recipient (Person Waiving Service)
*
Submit Request
Submit Request
Should be Empty: