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Demand for Judicial Determination of Forfeiture of Motor Vehicle (Minn. Stat. §169A.63, subd. 8)
(Name) (Address) (City/State) (Telephone) (Zip Code) Plaintiff/Claimant (Vehicle Seized-Year, Make, Model)

vs.
(VIN #) (Plate # ) Defendant

To: __________________________________________________________________
(list both law enforcement agency that initiated the forfeiture and the prosecuting authority)

Complaint: The plaintiff/claimant in this matter asks for a judicial decision on the forfeiture of the defendant motor vehicle pursuant to Minn. Stat. §169A.63 claiming the vehicle was improperly seized for the following reasons: (Specify why you are making this claim and your interest in the vehicle seized. Use additional sheet(s) if necessary.) 1.

2.

3.

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 FOR202 State ENG Rev 8/05 www.courts.state.mn.us/forms Page 1 of 1