Free STATE OF MINNESOTA - Minnesota

State of Minnesota
County

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

Select County

In the Matter of the Application of:
First Middle Last

On Behalf of (current name of minor(s)):

Affidavit of Personal Service
First Middle Last

For a change of name to (new name of minor(s)):
First Middle Last

STATE OF MINNESOTA COUNTY OF
(County where Affidavit signed)

) ) SS )

I, (Name of person who hand-delivered documents) 18 years of age having been born on and that on

, being sworn, state that I am at least

, I served the Application for a Name Change of a Minor and a notice of hearing upon (Full name of non-applicant parent) at (address where documents were served) by handing a true and correct copy of the documents to him/her.

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

Name: Sworn/affirmed before me this day of
Notary Public \ Deputy Court Administrator

Address: , . City/State/Zip: Telephone:

NAM205

State

ENG

Rev 5/02-D

www.courts.state.mn.us/forms

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