Free STATE OF MINNESOTA - Minnesota

State of Minnesota
County
Select County

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

Plaintiff/Petitioner

and
Defendant/Respondent

Affidavit of Service by Mail

STATE OF MINNESOTA COUNTY OF
(County where Affidavit signed)

) ) SS ) , being sworn, state that I am at least

I,
(Name of person who mailed documents)

18 years of age having been born on , , I served the following papers upon
(list all papers mailed to the other party)

, and that on

by placing in
(Name of other party)

an envelope a true and correct copy of each document addressed to at , State of , Zip Code in the City of and depositing the envelope, with

sufficient postage, in the United States Mail at the Post Office located in the City of
in

the State of

.

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

Name: Sworn/affirmed before me this day of , . Address: City/State/Zip: Telephone:
Notary Public \ Deputy Court Administrator

SOP104

State

ENG

Rev 1/02-D

www.courts.state.mn.us/forms

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