Free Microsoft Word - CSD703-1 - Minnesota

State of Minnesota County

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

Plaintiff / Petitioner vs / and AFFIDAVIT OF DEFAULT OF CHILD SUPPORT JUDGMENT Minn. Stat. § 548.091, subd. 2a

Defendant / Respondent

STATE OF MINNESOTA ) COUNTY OF ____________________ ) SS
(County where Affidavit Signed)

, being duly sworn on oath deposes and states that s/he is the According to the order dated per . , the obligor is to pay $

as and for child support. Judgment was obtained by operation of law for

unpaid child support as follows: Payment Due Date(s) Amount Due Amount Paid

CSD703

State

ENG

4/08

www.mncourts.gov/forms

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The obligor's full name is obligor's last known employer is obligor's last known address is City of obligor is not in the Armed Services. All child support payments are payable to , State of

. The . The , in the . The

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

Sworn / affirmed before me this _________day of ,

Print Name: Address: City/State/Zip:

Notary Public/ Deputy Court Administrator

Telephone: (

)

CSD703

State

ENG

4/08

www.mncourts.gov/forms

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