Free State of Minnesota - 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
Defendant / Respondent Intervenor STATE OF MINNESOTA ) COUNTY OF ____________________ ) SS
(County where Affidavit Signed)

Affidavit of Personal Service Affidavit of Service By Mail

I,
(Name of person who served documents) (Date service made)

, being duly sworn, upon oath, state than 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 above at ____ o'clock ___.m. at
(Address where documents delivered)

named

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

CSX102

State

ENG

Rev 5/08

www.mncourts.gov/forms

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