Free EX PARTE MOTION TO REINSTATE RECREATIONAL LICENSE - Minnesota

State of Minnesota County Select County

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



In Re the Marriage of:

Plaintiff / Petitioner

Affidavit in Support of Motion to Reinstate Driver's License
vs / and Defendant / Respondent Intervenor
STATE OF MINNESOTA ) COUNTY OF ____________________ ) SS
(County where Affidavit Signed)

I, , being first duly sworn, state the following reasons why an order for reinstating my driver's license(s) should be granted.
Check one of the statements below that apply:

I have never entered into a written payment agreement and request that the court establish a payment agreement pursuant to Minn. Stat. § 518A.69. I have signed a written payment agreement but request that the court make changes to the payment agreement by taking into consideration my circumstances described briefly below.

Dated: Signature (Sign only in presence of Notary or Court Deputy) Sworn / affirmed before me this _________day of , Print Name: Address: City/State/Zip: Telephone:

Notary Public/ Deputy Court Administrator

CSX1203

State

ENG

Rev 12/06

www.mncourts.gov/forms

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