Free STATE OF MINNESOTA DISTRICT COURT - Minnesota

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Court File Number: Case Type: Dissolution without Children

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In Re the Marriage of: , Name of Petitioner and . Name of Respondent I, the undersigned Respondent, acknowledge that I have personally received a copy of the Summons and Petition for Dissolution of Marriage. I understand that: 1. Signing this document starts the divorce/dissolution process; 2. Signing this document does not mean that I agree with everything in the Petition for Dissolution of Marriage. It only means that I have received a copy of the Summons and Petition; 3. I have thirty (30) days from the date of signing this document to serve on the Petitioner an Answer to the Petition; 4. If I do not serve an Answer within thirty (30) days, I will be found in default and Petitioner may ask the Court to give him/her everything (s)he has asked for in the Petition for Dissolution of Marriage; 5. I do not have to sign this Admission. But if I do not sign, Petitioner can commence the divorce/dissolution by having the Summons and Petition for Dissolution of Marriage personally served upon me and I may have to pay the cost of Petitioner doing this. I declare, under penalty of perjury, that I personally received a copy of the Summons and Petition at , on .
(City) (State) (Month/Day/Year you received the papers).

Admission of Service Summons and Petition for Dissolution of Marriage

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

Name: Sworn/affirmed before me Date:
Notary Public \ Deputy Court Administrator

Address: City/State/Zip: Telephone:

DIV405

State

ENG

Rev 12/2001-D

www.courts.state.mn.us/forms

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