Free Microsoft Word - HOU108 - Minnesota

State of Minnesota
County

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

Select County

Plaintiff

Affidavit of Service By Mail
vs.
Defendant

Hearing Date: Time: STATE OF MINNESOTA ) ) COUNTY OF _________________)
(County where Affidavit signed)

ss.

I,
(Name of person who mailed documents)

, being sworn/affirmed upon oath state that on , I served a Summons and Complaint in an Eviction action upon
(Date documents mailed)

by placing a true and correct copy of the documents
(Name of person(s) to whom documents were mailed)

in an envelope addressed to the person(s) at his/her last known address of
(Street address of person to whom

in the City of
documents were mailed)

, State of Minnesota, and whose Zip

Code is

, and depositing the envelope, with sufficient postage in the U.S. Mail at the , State of Minnesota.

Post Office located in the City of

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

Name: Subscribed and sworn to before me this day of , . Address: City/State/Zip: Telephone:
Notary Public \ Deputy Court Administrator

HOU108

State

ENG

Rev 8/08

www.mncourts.gov/forms

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