Free REQUEST FOR A HEARING TO STOP COST-OF-LIVING ADJUSTMENT - Minnesota

State of Minnesota County Select County

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



In Re the Marriage of:

Plaintiff / Petitioner

vs / and

Affidavit of Personal Service Affidavit of Service By Mail

Defendant / Respondent Intervenor STATE OF MINNESOTA ) COUNTY OF ____________________ ) SS
(County where Affidavit Signed)

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

, being duly sworn, upon oath, state that on
(Title of Documents hand delivered or mailed)

___________________, I served the attached documents, namely upon (check one):
Plaintiff / Petitioner (Name) Defendant / Respondent (Name) County Attorney's Office (Name) Other (Name) by (check method of service used): Personally handing a true and correct copy of the document(s) to the person(s) named above at ______ o'clock ___.m. at .
(a.m. or p.m.) (Address where documents delivered)

Mailing a true and correct copy of the document(s) to the person(s) named above by placing the document(s) in an envelope with sufficient postage in the United States mail at the Post Office located in the City of , State of , at the person's last known address of:

Dated:
Signature ( Sign only in presence of Notary or Court Deputy)

Print Name: Subscribed and sworn to before me this _________day of , Address: City/State/Zip: Telephone: Notary Public/ Deputy Court Administrator
CSD101 State ENG Rev 5/08-D www.mncourts.gov/forms Page 1 of 1