Free STATE OF MINNESOTA DISTRICT COURT - Minnesota


File Size: 115.6 kB
Pages: 1
Date: May 27, 2008
File Format: PDF
State: Minnesota
Category: Court Forms - State
Author: GulbransoR
Word Count: 227 Words, 1,454 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.courts.state.mn.us/forms/public/forms/Divorce__Dissolution/Petition_for_Divorce_with_Children/DIV810.pdf

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Preview STATE OF MINNESOTA DISTRICT COURT
State of Minnesota
County
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District Court
Judicial District: Court File Number: Case Type:
Dissolution without Children

In Re the Application of:
First Middle Last Name

Felony Notification Affidavit
For a change of name to:
First Middle Last Name

STATE OF MINNESOTA COUNTY OF
(County where Affidavit signed)

) )SS



Application for Name Change Application for a Marriage License with Name Change Application for Name Change Pursuant to a Marriage Dissolution

A notice pursuant to Minn. Stat. 259.13 was served upon the prosecuting authority that obtained the conviction on the day of and which proof of service day of . has been filed with the court on the If the prosecuting authority who obtained the conviction is from another state other than Minnesota or federal jurisdiction a notice was served also on the Minnesota Attorney General at 102 State Capitol Building, St. Paul, MN 55155 and which proof of service has been filed with the court on the day of . In reference to the above a period of 30 days has passed since notifying the prosecuting authority. A person who knowingly violates Minnesota Stat. 259.13 is guilty of a gross misdemeanor.

Dated:
Signature

Name: Subscribed and sworn to before me this ______ day of ______________,_____. ______________________________
Notary Public\Deputy Court Administrator
DIV810 State ENG Rev 5/08-D www.mncourts.gov/forms Page 1 of 1

Street Address: City/State/Zip: Telephone