Free STATE OF MINNESOTA - Minnesota

State of Minnesota
County

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

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Petitioner

and

Affidavit for Filing Foreign Protective Order

Respondent

STATE OF MINNESOTA COUNTY OF
(County where Affidavit signed)

) ) SS ) , being sworn, state that I am the

I,

person filing a foreign protective order pursuant to Minn. Stat. § 518B.01, subd 19a.

I further state my belief that the foreign protective order filed with this affidavit is a valid order and has not been amended, rescinded or superseded by any orders from a court of competent jurisdiction.

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

OFP503

State

ENG

Rev 8/06

www.mncourts.gov/forms

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