Free Microsoft Word - JGM106 - Minnesota

State of Minnesota
County of

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

Select County

Plaintiff vs.

Affidavit of Increased Costs

Defendant STATE OF MINNESOTA ) ) COUNTY OF _____________________)
(County where Affidavit signed)

ss.

, Affiant, being duly sworn on oath says that (circle one) he / she is the (circle one) creditor / attorney for the creditor / agent for the creditor, in the above entitled action and that the following is a true statement of the increased costs incurred in the enforcement of the judgment in said action. It is further said that the increased costs (circle one) do / do not contain any additional attorney's fees.

Writ of Execution Fee Service Fee Other Increased Costs (Please specify)

$ $

$ $ $ $ TOTAL $0

Dated:

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

Address City/State Subscribed and sworn to before me this ______ day of ________________, 20____.
Notary Public/Deputy Court Administrator

Phone #

JGM106

State

ENG

Rev 8/08

www.mncourts.gov/forms

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