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This summons is issued pursuant to Rule 4, CRCP, as amended. A copy of the complaint must <br />be served with this summons. <br />RETURN OF SERVICE <br />State of Colorado ) <br />County of ) ss/ <br />I declare under oath that I served this summons and a copy of the Appeal and Petition for Review of <br />Final Administrative Action and District Civil Case Cover Sheet in this case on the <br />, in the County of , Colorado on , 20_ at <br />_.m. at the following location: <br />• by handing it to a person identified to me as the defendant. <br />• by leaving it with the defendant, who refused service. <br />• by leaving it with <br />designated to receive service for the defendant. <br />❑ I am over the age of 18 years and am not interested in nor a party to this case. <br />❑ 1 attempted to serve the defendant on occasions, but have not been able to <br />locate the defendant. <br />Signature Date <br />[) Private Process Server <br />[ J Sheriff, County <br />[ ] Service $ <br />[ J Mileage $ <br />Signed under oath before me on the day of , 20____, by <br />Notary Public <br />3 <br />