ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): OR 
GOVERNMENTAL AGENCY (under Family Code, §§ 17400 and 17406)

FOR COURT USE ONLY

FL-605

TELEPHONE NO. (Optional):

E-MAIL ADDRESS (Optional):

ATTORNEY FOR (Name):

FAX NO. (Optional):

NAME OF COURT, JUDICIAL DISTRICT, AND BRANCH COURT, IF ANY:

PLAINTIFF/PETITIONER:

DEFENDANT/RESPONDENT:

OTHER PARENT:

To (name of person served):

NOTICE AND ACKNOWLEDGMENT OF RECEIPT 
(Governmental)

CASE NUMBER:

NOTICE
The documents described below are being served on you by mail with this acknowledgment form. If you are being served on behalf 
of a corporation, an unincorporated association (including a partnership), or other entity, you must sign this acknowledgment in the 
name of the entity or a person authorized to receive service of process on behalf of the entity must sign the form to acknowledge 
receipt of the documents. In all other cases, you must personally sign, or a person authorized by you must sign this form to 
acknowledge receipt of the documents.

If the documents described below include a Summons and you fail to complete and return this acknowledgment form to the sender 
within 20 days of the date of mailing, you will be liable for the reasonable expenses incurred after that date in serving you or in 
attempting to serve you by any other methods permitted by law. If you return this form to the sender, service of a Summons is 
deemed complete on the date you sign the acknowledgment of receipt below.

Date of mailing:

(TYPE OR PRINT NAME)

(SIGNATURE OF SENDER)

ACKNOWLEDGMENT OF RECEIPT

I agree I received the following (to be completed by sender before mailing):

1.

2.

A copy of the Summons and Complaint (form FL-600) and proposed Judgment Regarding Parental Obligations (form FL-630) 
and a blank Answer to Complaint or Supplemental/Amended Complaint Regarding Parental Obligations (form FL-610).

A copy of the Summons with standard restraining orders, and
(a)

an Order to Show Cause (form FL-300) and a blank Responsive Declaration to Order to Show Cause or Notice of
Motion (form FL-320)
a completed and a blank Income and Expense Declaration (form FL-150).

(b)

3.

Other documents (specify):

(To be completed by recipient):  
Date this acknowledgment is signed:

(TYPE OR PRINT NAME)

(SIGNATURE OF PERSON ACKNOWLEDGING RECEIPT)

Petitioner/Plaintiff

Attorney of Record

Respondent/Defendant

Other (specify):

Other parent

Form Adopted for Mandatory Use 
Judicial Council of California 
FL-605 [Rev. January 1, 2007]

NOTICE AND ACKNOWLEDGMENT OF RECEIPT 
(Governmental)

Page 1 of 1

Code of Civil Procedure, §§ 415.30, 417.10;   
                      Cal. Rules of Court, rule 5.110
www.courtinfo.ca.gov