Free Microsoft Word - JGM103 - Minnesota

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_______________________________________ _______________________________________ _______________________________________ Plaintiff vs. _______________________________________ _______________________________________ _______________________________________ Defendant

Affidavit of Identification of Judgment Creditor (Minn. Stat. §548.28, subd. 1)

STATE OF MINNESOTA

) ) COUNTY OF _________________)
(County where Affidavit signed)

ss.

___________________________________________ being duly sworn/affirmed on oath says; that he/she is the Judgment Creditor, or the _________________________ for the Judgment Creditor, that to the best of his/her knowledge, information, and belief, the full name(s) of the Judgment Creditor(s) in the action above entitled is as follows: That the business and occupation of said judgment creditor(s) is as follows:

That the place(s) of residence of said judgment creditor(s) is as follows:

That the place(s) of business of said judgment creditor(s) is as follows:

That the post office address(es) of said judgment creditor(s) is as follows:

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

JGM103

State

ENG

Rev 8/08

www.mncourts.gov/forms

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