State of Minnesota
Judicial District: Court File Number: Case Type:
Affidavit for Filing Foreign Protective Order
STATE OF MINNESOTA COUNTY OF
(County where Affidavit signed)
) ) SS ) , being sworn, state that I am the
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state my belief that the foreign protective order filed with this affidavit is a valid order and has not been amended, rescinded or superseded by any orders from a court of competent jurisdiction.
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
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