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These rules shall be known as the Mississippi Rules of Civil Procedure and may be cited as M.R.C.P.; e. g., M.R.C.P. 85. 195 APPENDIX A. FORMS [See Rule 84] INTRODUCTORY STATEMENT 1. The forms contained in the Appendix of Forms are sufficient under the rules. They are limited in number. No attempt is made to furnish a manual of forms. 2. Except where otherwise indicated, each pleading, motion, and other paper should have a caption similar to that of the summons, with the designation of the particular paper substituted for the word “Summons.” In the caption of the summons and in the caption of the complaint all parties must be named but in other pleadings and papers it is sufficient to state the name of the first party on each side, with an appropriate indication of other parties. See M.R.C.P. 4(b), 7(b)(2), and 10(a). 3. Each pleading, motion, and other paper is to be signed by at least one attorney of record in his individual name (M.R.C.P. 11). The attorney’s name is to be followed by his address as indicated in Form 2. In forms following Form 2 the signature and address are not indicated. 4. If a party is not represented by an attorney, the signature and address of the party are required in place of those of the attorney (M.R.C.P. 11). 196 FORM 1A. SUMMONS (Process Server) IN THE COURT OF COUNTY, MISSISSIPPI A.B., Plaintiff(s) CD., Defendant(s) v. Civil Action, File No. SUMMONS THE STATE OF MISSISSIPPI TO: (Insert the name and address of the person to be served) NOTICE TO DEFENDANT(S) THE COMPLAINT WHICH IS ATTACHED TO THIS SUMMONS IS IMPORTANT AND YOU MUST TAKE IMMEDIATE ACTION TO PROTECT YOUR RIGHTS. You are required to mail or hand deliver a copy of a written response to the Complaint to , the attorney for the Plaintiff(s), whose post office address is and whose street address is . Your response must be mailed or delivered within (30) days from the date of delivery of this summons and complaint or a judgment by default will be entered against you for the money or other things demanded in the complaint. You must also file the original of your response with the Clerk of this Court within a reasonable time afterward. Issued under my hand and the seal of said Court, this day of , 20 . Clerk of County, Mississippi (Seal) 197 [This form shall appear on the reverse side of Form 1A. Summons (Process Server)] PROOF OF SERVICE--SUMMONS (Process Server) [Use separate proof of service for each person served] Name of Person or Entity Served I, the undersigned process server, served the summons and complaint upon the person or entity named above in the manner set forth below (process server must check proper space and provide all additional information that is requested and pertinent to the mode of service used): FIRST CLASS MAIL AND ACKNOWLEDGEMENT SERVICE. By mailing (by first class mail, postage prepaid), on the date stated in the attached Notice, copies to the person served, together with copies of the form of notice and acknowledgement and return envelope, postage prepaid, addressed to the sender (Attach completed acknowledgement of receipt pursuant to M.R.C.P. Form 1B). PERSONAL SERVICE. I personally delivered copies to on the day of , 20 , where I found said person(s) in County of the State of . RESIDENCE SERVICE. After exercising reasonable diligence I was unable to deliver copies to said person within county, (state). I served the summons and complaint on the day of , 20 , at the usual place of abode of said person by leaving a true copy of the summons and complaint with who is the (here insert wife, husband, son, daughter or other person as the case may be), a member of the family of the person served above the age of sixteen years and willing to receive the summons and complaint, and thereafter on the day of , 20 , I mailed (by first class mail, postage prepaid) copies to the person served at his or her usual place of abode where the copies were left. CERTIFIED MAIL SERVICE. By mailing to an address outside Mississippi (by first class mail, postage prepaid, requiring a return receipt) copies to the person served. (Attach signed return receipt or the return envelope marked “Refused.”) 198 At the time of service I was at least 18 years of age and not a party to this action. Fee for service: $ Process server must list below: [Please print or type] Name Address Telephone No. State of ) County of ) Personally appeared before me the undersigned authority in and for the state and county aforesaid, the within named who being first by me duly sworn states on oath that the matters and facts set forth in the foregoing “Proof of Service-Summons” are true and correct as therein stated. Sworn to and subscribed before me this the day of 20 . Process Server (Signature) (Seal) My Commission Expires: [Adopted effective March 1, 1985; amended effective May 2, 1985; amended March 17, 1995; amended December 21, 2022.] Notary Public 199 FORM 1AA. SUMMONS (Sheriff) IN THE COURT OF COUNTY, MISSISSIPPI A.B., Plaintiff(s) C.D., Defendant(s) v. Civil Action, File No. SUMMONS THE STATE OF MISSISSIPPI TO: (Insert the name and address of the person to be served) NOTICE TO DEFENDANT(S) THE COMPLAINT WHICH IS ATTACHED TO THIS SUMMONS IS IMPORTANT AND YOU MUST TAKE IMMEDIATE ACTION TO PROTECT YOUR RIGHTS. You are required to mail or hand-deliver a copy of a written response to the Complaint to , the attorney for the Plaintiff(s), whose post office address is , and whose street address is . Your response must be mailed or delivered within (30) days from the date of delivery of this summons and complaint or a judgment by default will be entered against you for the money or other things demanded in the complaint. You must also file the original of your response with the Clerk of this Court within a reasonable time afterward. Issued under my hand and the seal of said Court, this day of , 20 . Clerk of County, Mississippi (Seal) 200 [This form shall appear on the reverse side of Form 1AA: Summons (Sheriff)] RECEIVED THIS DAY OF , 20 . BY SHERIFF SHERIFF’S RETURN State of Mississippi ) County of ) ( ) I personally delivered copies of the summons and complaint on the day of , 20 , to: . ( ) After exercising reasonable diligence I was unable to deliver copies of the summons and complaint to within County, Mississippi. I served the summons and complaint on the day of , 20 , at the usual place of abode of said , by leaving a true copy of the summons and complaint with , who is the (here insert wife, husband, son, daughter or other person so as the case may be), a member of the family of the person served above the age of sixteen years and willing to receive the summons and complaint, and thereafter on the day of , 20 , I mailed (by first class mail, postage prepaid) copies to the person served at his or her usual place of abode where the copies were left. ( ) I was unable to serve the summons and complaint. This the day of , 20 . Sheriff of County, Mississippi By: , Deputy Sheriff 201 [Note: All summons issued to the sheriff must be returned within thirty days from the day the summons was received by the sheriff pursuant to the requirements of Mississippi Rule of Civil Procedure 4(c)(2)]. [Adopted effective March 1, 1985; amended effective February 1, 1990; amended December 21, 2022.] 202 FORM 1B. NOTICE AND ACKNOWLEDGMENT FOR SERVICE BY MAIL IN THE COURT OF COUNTY, MISSISSIPPI A.B., Plaintiff(s) (include appropriate designation of other plaintiffs) v. Civil Action, File No. C.D., Defendant(s) (include appropriate designation of other defendants) TO: (Insert the name and address of the person to be served) NOTICE The enclosed summons and complaint are served pursuant to Rule 4(c)(3) of the Mississippi Rules of Civil Procedure. You must sign and date the acknowledgment at the bottom of this page. If you are served on behalf of a corporation, unincorporated association (including a partnership), or other entity, you must indicate under your signature your relationship to that entity. If you are served on behalf of another person and you are authorized to receive process, you must indicate under your signature your authority. If you do not complete and return the form to the sender within 20 days of the date of mailing shown below, you (or the party on whose behalf you are being served) may be required to pay any expenses incurred in serving a summons and complaint. If you do complete and return this form, you (or the party on whose behalf you are being served) must respond to the complaint within 30 days of the date of your signature. If you fail to do so, judgment by default will be taken against you for the relief demanded in the complaint. I declare that this Notice and Acknowledgement of Receipt of Summons and Complaint was mailed on (Insert date) Signature 203 THIS ACKNOWLEDGMENT OF RECEIPT OF SUMMONS AND COMPLAINT MUST BE COMPLETED I acknowledge that I have received a copy of the summons and of the complaint in the above-captioned matter in the State of . Signature (Relationship to Entity/Authority to Receive Service of Process) Date of Signature State of ) County of ) Personally appeared before me, the undersigned authority in and for the State and County aforesaid, the above named , who solemnly and truly declared and affirmed before me that the matters and facts set forth in the foregoing Acknowledgement of Receipt of Summons and Complaint are true and correct as therein stated. Affirmed and subscribed before me this day of , 20 . Notary Public My Commission Expires (Seal) [Adopted effective March 1, 1985; amended effective May 2, 1985; amended March 17, 1995; amended December 21, 2022.] 204 FORM 1C. SUMMONS BY PUBLICATION IN THE COURT OF COUNTY, MISSISSIPPI A.B., Plaintiff(s) (It is sufficient here to state the name of the first plaintiff with an appropriate designation of other plaintiffs.) v. Civil Action, File No. CD., Defendant(s) (It is sufficient here to state the name of the first defendant with an appropriate designation of other defendants.) SUMMONS THE STATE OF MISSISSIPPI TO: (Insert name of the person(s) to be served) You have been made a Defendant in the suit filed in this Court by (Insert name of all Plaintiffs), Plaintiff(s), seeking (Insert a brief description of the relief being sought). Defendants other than you in this action are (insert names of all defendants other than the person or persons who are the subject of this summons). You are required to mail or hand deliver a written response to the Complaint filed against you in this action to , Attorney for Plaintiff(s), whose post office address is and whose street address is . YOUR RESPONSE MUST BE MAILED OR DELIVERED NOT LATER THAN THIRTY DAYS AFTER THE DAY OF , 20 , WHICH IS THE DATE OF THE FIRST PUBLICATION OF THIS SUMMONS. IF YOUR RESPONSE IS NOT SO MAILED OR DELIVERED, A JUDGMENT BY DEFAULT WILL BE ENTERED AGAINST YOU FOR THE MONEY OR OTHER RELIEF DEMANDED IN THE COMPLAINT. You must also file the original of your Response with the Clerk of this Court within a reasonable time afterward. Issued under my hand and the seal of said Court, this day of , 20 . 205 Clerk of County, Mississippi (Seal) [Adopted effective March 1, 1985; amended effective May 2, 1985; amended December 21, 2022.] 206 FORM 1D. RULE 81 SUMMONS (Sheriff or Process Server) IN THE COURT OF COUNTY, MISSISSIPPI A. B., Plaintiff(s) C. D., Defendant(s) v. Civil Action, File No. SUMMONS THE STATE OF MISSISSIPPI TO: (Insert the name NOTICE TO DEFENDANT(S) THE COMPLAINT OR PETITION WHICH IS ATTACHED TO THIS SUMMONS IS IMPORTANT AND YOU MUST TAKE IMMEDIATE ACTION TO PROTECT YOUR RIGHTS. You are summoned to appear and defend against said complaint or petition at ___O’clock ____.M. on the day of 20 , in the courtroom of the County Courthouse at , Mississippi, and in case of your failure to appear and defend a judgment will be entered against you for the money or other things demanded in the complaint or petition. You are not required to file an answer or other pleading but you may do so if you desire. Issued under my hand and the seal of said Court, this day of , 20 . (Seal) (Note: All summons issued to the sheriff must be returned prior to the time the defendant is summoned to appear.) [Adopted effective January 10, 1986; amended December 21, 2022.] Clerk of County, Mississippi 207 FORM 1DD. RULE 81 SUMMONS (Summons by Publication) IN THE COURT OF COUNTY, MISSISSIPPI A.B., Plaintiff(s) (It is sufficient here to state the name of the first plaintiff with an appropriate designation of other plaintiffs.) v. Civil Action, File No. C.D., Defendant(s) (It is sufficient here to state the name of the first defendant with an appropriate designation of other defendants.) SUMMONS THE STATE OF MISSISSIPPI TO: (Insert name of the person(s) to be served.) You have been made a Defendant in the suit filed in this Court by , (Insert name of all Plaintiffs) Plaintiff(s) seeking (Insert a brief description of the relief being sought). Defendants other than you in this action are (Insert names of all defendants other than the person or persons who are the subject of this summons) You are summoned to appear and defend against the complaint or petition filed against you in this action at o’clock _. M. on the day of , 20 , in the courtroom of the County Courthouse at , Mississippi, and in case of your failure to appear and defend, a judgment will be entered against you for the money or other things demanded in the complaint or petition. You are not required to file an answer or other pleading but you may do so if you desire. Issued under my hand and the seal of said Court, this day of , 20 . Clerk of County, 208 (Seal) Mississippi 209 FORM 1E. WAIVER OF PROCESS IN THE COURT OF COUNTY, MISSISSIPPI A.B. Plaintiff v. C.D. Defendant Civil Action, File No. WAIVER OF PROCESS The undersigned (name ), whose post office address is and whose street address is , does hereby waive the service of summons and (designate any pleading on which service is being waived ) upon myself in this cause. In executing this document I certify that I am not an unmarried minor and am not mentally incompetent. (In addition the person executing the waiver may add any or all of the following to the document:) [Furthermore, by the filing of this document, I enter my appearance in this cause] just as if I had been served more than 30 days prior to this date] [and agree that this action may be heard and disposed of without further notice to me] [and join in this action and in the prayer for relief] This the day of , 20 . Name STATE OF ) COUNTY OF ) Personally appeared before me, the undersigned authority for the jurisdiction aforesaid, the within named who acknowledged that he signed and delivered the above and foregoing instrument on the day and year therein mentioned. Given under my hand this the day of , 20 . 210 Notary Public My Commission Expires: [In lieu of the above acknowledgment the following oath may be used:] STATE OF ) COUNTY OF ) Personally appeared before me the undersigned authority in and for the jurisdiction aforesaid the within named who, being first by me duly sworn, states on oath that the matters and facts set forth in the foregoing instrument are true and correct as therein stated. Sworn to and subscribed before me this the day of , 20 . Name Notary Public My Commission Expires: [Adopted effective February 1, 1990; amended effective July 1, 2009 to delete convicted felony exception; amended December 21, 2022.] 211 FORM 2. MOTION FOR SUBSTITUTION - DECEASED PLAINTIFF OR DECEASED DEFENDANT [Plaintiff, defendant or any party’s successor or representative] shows to the court that , the above-named [plaintiff or defendant], died intestate (or testate) on or about the day of , 20 ; that letters of administration upon the estate of the said were issued on the day of , 20 , to as administrator by the Court of the State of Mississippi (or, that was duly appointed executor of the last will of by the Court of the State of Mississippi and qualified as such executor on the day of , 20 ): and this is an action for [state briefly nature of action] and the claim [of Plaintiff _______ or against Defendant _______] was not extinguished by the death of [Plaintiff _______ or Defendant_______]. Wherefore [plaintiff, defendant or any party’s successor or representative] moves the court for an order substituting , administrator (or, as the case may be, executor) of the estate of , deceased, as party [plaintiff or defendant] herein. FORM 3. APPLICATION TO CLERK FOR ENTRY OF DEFAULT AND SUPPORTING AFFIDAVIT The clerk is requested to enter default against the defendant in the above entitled action for failure to plead, answer or otherwise defend as set out in the affidavit hereto annexed. Attorney for Plaintiff State of Mississippi) County of ) , being duly sworn, deposed and says: 1. That he is attorney of record of the plaintiff, and has personal knowledge of the facts set forth in this affidavit. 2. That the defendant was duly served with a copy of the summons, together with a copy of plaintiffs complaint, on the day of , 20 . 212 3. That more than 30 days have elapsed since the date on which the said defendant was served with summons and a copy of the complaint. 4. That the defendant has failed to answer or otherwise defend as to plaintiffs complaint, or serve a copy of any answer or other defense which he might have upon the undersigned attorney of record for the plaintiff. 5. That this affidavit is executed by affiant herein in accordance with Rule 55(a) of the Mississippi Rules of Civil Procedure, for the purpose of enabling the plaintiff to obtain an entry of default against the defendant, for his failure to answer or otherwise defend as to the plaintiffs complaint. Sworn to and subscribed before me this the day of , 20 . Attorney for Plaintiff Notary Public FORM 4. DOCKET OF ENTRY OF DEFAULT Default entered against defendant this day of , 20 . FORM 5. DEFAULT JUDGMENT ENTERED BY COURT This action came on for hearing on the motion of the plaintiff for a default judgment pursuant to Rule 55(b) of the Mississippi Rules of Civil Procedure, and the defendant having been duly served with the summons and complaint and not being an infant or an unrepresented incompetent person and having failed to plead or otherwise defend, and his default having been duly entered and the defendant having taken no proceedings since such default was entered, It is Ordered and Adjudged that [here set forth relief granted to plaintiff]. This day of , 20 . 213 Judge APPENDIX B. STATUTES AFFECTED [DELETED IN ITS ENTIRETY.] [Effective June 24, 1992.] APPENDIX C. TIME TABLE FOR PROCEEDINGS UNDER THE MISSISSIPPI RULES OF CIVIL PROCEDURE [DELETED IN ITS ENTIRETY.] [Effective June 24, 1992.] 214