Free Microsoft Word - OFP601 - Minnesota

State of Minnesota County Select County

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

Domestic Abuse

In the Matter of:

Petitioner vs.

Affidavit and Order for Dismissal

Respondent. STATE OF MINNESOTA ) ) COUNTY OF _________________)
(County where Affidavit signed)

ss.

Petitioner, being under oath, states that: 1. A Domestic Abuse Protection Order was issued in this action on_______________________________.
(Date)

2. I am requesting the Court to vacate the Order for Protection and dismiss this action because: _________

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

Subscribed and sworn to before me this day of , .

Name: Address: City/State/Zip:

Notary Public \ Deputy Court Administrator

Telephone: Based on the foregoing, IT IS HEREBY ORDERED that the above matter is dismissed. This does not modify any current conditions of release ordered in any criminal file. Dated: Judge of District Court _________________________________________________________________________________________ Distribution
______ Original ­ service by mail Copy for Petitioner(s) Copy for file until original returned Copy for Sheriff Dissolution File
OFP601 State ENG Rev 8/08

Copy for Respondent(s) Copy for local police department Other:
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