APPENDIX 28.3A: WAIVER OF CITATION, SERVICE, AND NOTICE IN A LA.-C.C.
ART. 103 DIVORCE
__________________________________ __________JUDICIAL DISTRICT COURT
VERSUS DOCKET NO. _______________________
__________________________________ ________________ PARISH, LOUISIANA
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WAIVER OF CITATION, SERVICE, AND NOTICE IN A LA.-C.C. ART. 103 DIVORCE
STATE OF LOUISIANA
PARISH OF ____________________
BEFORE ME, the undersigned authority, personally came and appeared:
________________________________________
(Print name)
who after being duly sworn did depose and state that:
Affiant does formally and expressly: (1) acknowledge receipt of a certified copy of the
Petition for Divorce filed pursuant to Civil Code Art. 103 in this proceeding; and accept service
thereof; and (2) waive only the items initialed below:
___(a) the necessity of issuance of formal citation and service of process of the original petition;
___(b) all legal delays allowed by law, particularly those delays allowed for answering and/or
excepting to the pleading pursuant to Code of Civil Procedure Articles 1001 and 1002;
___(c) notice of trial pursuant to Code of Civil Procedure Art. 1571 and appearance at trial; and
___(d) notice of the entry of the preliminary default pursuant to Code of Civil Procedure Art.
1702(A).
Affiant acknowledges that the signature hereon will allow mover to go forward with the
merits of the divorce only in affiant's absence, and further understands that it is mover’s intent to
do so.
__________________________________
Sign your Name
___________________________________
Print your name
Sworn to and subscribed before me this _____day of _______________, 20_____.
___________________________________
NOTARY PUBLIC
Print name: _________________________
Bar Roll #:__________________________
My commission expires: _______________
Revised July 1, 2017
