Free STATE OF MINNESOTA - Minnesota

State of Minnesota
County

District Court
Judicial District: Court File Number: Case Type:

Select County

Dissolution with Children

In Re the Marriage of:
Name of Petitioner

and
Name of Respondent

Affidavit of Personal Service

STATE OF MINNESOTA COUNTY OF
(County where Affidavit signed)

) ) SS )

I,
(Name of person who hand-delivered documents)

, being sworn, state that I am at least , and that on , , I served the
(list all papers handed to the other party)

18 years of age having been born on

upon
(list all papers handed to the other party) (Name of other party)

by handing a true and correct copy of the documents to him/her.

Dated:
Signature of Person Who Served Documents
(Sign only in front of notary public or court administrator.)

Name: Subscribed and sworn to before me this day of , . Address: City/State/Zip: Telephone:
Notary Public\Deputy Court Administrator

DIV903

State

ENG

Rev 5/08-D

www.mncourts.gov/forms

Page 1 of 1