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State: Minnesota
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State of Minnesota
County Judicial District: Court File Number: Case Type:

District Court

In the Matter of:
Name of Plaintiff(s)/Tenant(s)


Verified Petition For Possession Of Residential Rental Property Following Unlawful Removal Or Exclusion (Lockout Petition Under Minn. Stat. 504B.375)

Name of Defendant(s)/Building Owner(s)

My name is

, I understand that I am under

oath and that in answering the following questions I must tell the truth: 1. I am the tenant with the right to live at the property located at the following address: Address:
Street Address Apt. or Unit Number State Zip Code


County: Phone: 2. The name, address, and phone number for the owner(s) of the property are: Name: Address:
Street Address Apt. No. City State Zip Code

Phone: 3. The name, address, and phone number for the manager(s) of the property (if different from the owner) are: Name: Address:
Street Address Apt. No. City State Zip Code

HOU702 State ENG Rev 2/05-D Page 1 of 3


On the following date, _______________________, defendant(s) and I entered into an agreement for me to rent the property. The rent is $ _____________ per month and is due on the _____________day of each month.


I am attaching the following documents, if any, which show that I have a right to live at the property: _____________________________________________________________

________________________________________________________________________ ________________________________________________________________________ 6. No judgment and writ of recovery (eviction order) has been issued by a court against me in favor of defendant(s) regarding this property. 7. Defendant(s) unlawfully forced me out of my home or made it impossible for me to live there by doing the following (describe in detail who did what and when):

8. 9. 10.

The last date on which I was present at the property was __________________________. The defendant(s) has/have not followed the legal procedure for eviction. I ask the court to order one or more of the following: a. Directing the defendant(s) to allow me to immediately move back into the property. b. Directing the defendant(s) to allow me to have sufficient access to the property to move out my belongings. c. Ordering the defendant(s) to immediately stop their unlawful actions that are keeping me out of my home. d. e. Directing that the sheriff of this county shall enforce the Court's Order. Other:_____________________________________________________________ _________________________________________________________________ . f. Other relief that is deemed just and proper by the court.




Rev 2/05-D

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Verification and Acknowledgments: a. I have read this document. To the best of my knowledge, information , and belief the information contained in this document is well-grounded in fact and is warranted by existing law. b. I have not been determined by any court in Minnesota or in any other State to be a frivolous litigant and I am not the subject of an Order precluding me from serving or filing this document. c. I am not serving or filing this document for any improper purpose, such as to harass the other party or to cause delay or needless increase in the cost of litigation or to commit a fraud on the court. d. I understand that if I am not telling the truth or if I am misleading the court or if I am serving or filing this document for an improper purpose, the court can order me to pay money to the other party, including the reasonable expenses incurred by the other party because of the serving or filing this document, court costs, and reasonable attorney fees.

Signature of Plaintiff (Sign only in presence of notary public/deputy court administrator) Street Address: City/State/Zip: Telephone: Sworn/affirmed before me this day of ,

Notary Public/Deputy Court Administrator




Rev 2/05-D

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