Docketing Statement - Agency Review (Administrative)

1022GE J Approved January 22, 2018 / Revised May 1, 2019 Acceptance of Service Page 1 of 2 Name Address City, State, Zip Phone Check your email. You will receive information and documents at this email address . Email I am [ ] Plaintiff/Petitioner [ ] Defendant/Respondent [ ] Plaintiff/Petitioner [ ] Defendant/Respondent (Utah Bar #: ) In the District Court of Ut ah Judicial District County Court Address Plaintiff/Petitioner v. Defendant/Respondent Acceptan ce of Service ( U tah R ule of C ivil P rocedure 4(d)(3) ) Case Number Judge Commissioner (domestic cases) 1. I have received the summons and complaint or petition in this case. 2. I understand that service is effective on the date I sign this document. 3. I know I can still respond to the complaint or petition in this case. I declare under criminal penalty under the law of Utah that everything stated in this docu ment is true . Signed at (city, and state or country). Sign atu Date Printed Name American LegalNet, Inc. www.FormsWorkFlow.com 1022GE J Approved January 22, 2018 / Revised May 1, 2019 Acceptance of Service Page 2 of 2 Certificate of Service I certify that I filed with the court and am serving a copy of this Acceptance of Service on the following people. Ser vice Method Service Address Service Date [ ] Mail [ ] Hand Delivery [ ] E - filed [ ] Email [ ] Left at business (With person in charge or in receptacle for deliveries.) [ ] Left at home (With person of suitable age and discretion residing ther e.) [ ] Mail [ ] Hand Delivery [ ] E - filed [ ] Email [ ] Left at business (With person in charge or in receptacle for deliveries.) [ ] Left at home (With person of suitable age and discretion residing there.) [ ] Mail [ ] Hand Delivery [ ] E - filed [ ] Email [ ] Left at business (With person in charge or in receptacle for deliveries.) [ ] Left at home (With person of suitable age and discretion residing there.) Sign atu Date Printed Name American LegalNet, Inc. www.FormsWorkFlow.com