Free Microsoft Word - CSD403 - Minnesota

State of Minnesota County Select County

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



In Re the Marriage of:

Plaintiff / Petitioner

Affidavit of
vs / and

(Fill in your name)
Defendant / Respondent STATE OF MINNESOTA COUNTY OF
(County where Affidavit signed)

) ) SS , being first duly sworn/affirmed, says that:

(Your name)

1. I am the Petitioner/Plaintiff/Respondent/Defendant (circle one) in this action: 2. I am employed by: Employer Address Work Number Length of Employment Gross Pay 3. I was previously employed by 4. I have the following additional sources of income: Source: $ per month $ per month Source: Source: $ per month 5. There has not been a sufficient cost-of-living or other increase in my income to allow for an adjustment in my child support.

Occupation Supervisor per (circle one) Monthly / Weekly / Semi-Monthly / Bi-Weekly for ________ years.

6. Copies of my tax returns and any other documentation of my income for the past three years,
,
(year) (year)

and
(year)

is provided to the other party of this action

as an attachment and provided to court administration. 7. I am submitting this affidavit in support of my motion to stop the cost-of-living adjustment. Dated: Subscribed and sworn to before me this Signature (Sign only in presence of Notary or Court Deputy) day of ,

Notary Public / Deputy Court Administrator
CSD403 State ENG Rev 6/08 www.mncourts.gov/forms Page 1 of 1