Free Microsoft Word - SPS104 - Minnesota

State of Minnesota County

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

Petitioner and SUPPLEMENTAL AFFIDAVIT OF DEFAULT OF MAINTENANCE JUDGMENT Minn. Stat. § 548.091, subd. 1

Respondent STATE OF MINNESOTA ) COUNTY OF ___________________ ) SS
(County where Affidavit Signed)

, being duly sworn on oath deposes and states that s/he is the Since the date of execution of the Affidavit of Default herein on the obligor has made payments in the amount of $ judgment should be entered against the obligor, favor of $ . . Accordingly, , and in for the unpaid balance in the amount of .

Signature ( Sign only in presence of Notary or Court Deputy)

Sworn / affirmed before me this _________day of ,

Print Name: Address: City/State/Zip:

Notary Public/ Deputy Court Administrator

Telephone: (

)

SPS104

State

ENG

4/08

www.mncourts.gov/forms

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