IN THE CIRCUIT COURT OF THE TENTH JUDICIAL CIRCUIT OF

IN THE CIRCUIT COURT OF THE TENTH JUDICIAL CIRCUIT

OF THE STATE OF FLORIDA, IN AND FOR POLK COUNTY

CASE NUMBER: _____________________________________

SECTION: 80

IN RE: THE MATTER OF

________________________________________,

Petitioner,

vs.

________________________________________,

Respondent.

ACCEPTANCE OF SERVICE (WAIVER OF SERVICE)

AND/OR ANSWER TO PETITION

I,________________________________________________________, hereby acknowledge receipt of a copy of the

__________________________________________________________________________________________________________filed by

_________________________________________in the above case. I hereby waive my right to be served with

Summons by the Sheriff’s Office or private process server and answer to the petition as follows:

By receiving the aforesaid document, and reviewing said contents, I acknowledge that I hereby:

(check one, please):

______AGREE to the terms of this petition

______DO NOT AGREE to the terms of this petition

______Other:_________________________________________________________________________

Dated this_____________day of_______________________________, 20_____.

_____________________________________________________________

Name (Printed)

_____________________________________________________________

Signature

Address:___________________________________________________

_____________________________________________________________

Phone:_____________________________________________________

STATE OF__________________________________________

COUNTY OF _______________________________________

Before me this________day of______________________, 20____, appeared______________________________________,

who was duly sworn and acknowledges the contents of this document.

__________________________________________________________ Personally known to me____________________

NOTARY PUBLIC ID Produced:_________________________________

My Commission Expires: