|
|
|
|
|
|
|
|
|
|
|
|
Date_______________, |
Clerk of the District Court |
by____________________ | |
(Seal) |
Name | Location of Service | Manner of Service | Date | Time |
(other than above) | ||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(Signature) | |
|
|
(Title) |
|
|
|
|
Method of Communication (in person or telephone) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(Signature) | |
|
|
(Name Printed) | |
|
|
(Title) |
TO: |
|
|
(Juvenile) | ||
|
|
|
(Father) | ||
|
|
|
(Mother) | ||
|
|
|
(Other having custody relationship) | (Address) |
On | ________, | ________, | ______, | at __ o'clock __m. | |
(day) | (date) | (year) |
Date: ________, |
Clerk of the District Court |
(Seal) | by ________________________ |
|
|
|
|
|
|
||||
|
|
|
|
|
|
|
|
|
|
Date Returned: ________, |
|
(Signature) | |
|
|
(Title) |
|
|
|
|
(in person or telephone) |
|
|
|
|
|
|
|
|
|
|
|
|
(Signature) | |
|
|
(Name Printed) | |
|
|
(Title) |
|
|
|
|
|
|
|
|
|
|
|
|
|
School | Grade |
Grades | Good______ | Fair______ | Poor______ |
Attendance | Good______ | Fair______ | Poor______ |
Behavior | Good______ | Fair______ | Poor______ |