State of Minnesota County
District Court Judicial District: Court File Number: Case Type:
In Re the Marriage of
Petitioner and AFFIDAVIT OF DEFAULT OF MAINTENANCE JUDGMENT Minn. Stat. ยง 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 According to the order dated per arrears. For the period , payments due amounted to $ $ , and the total amount unpaid is $ , the obligor is to pay $ .
as and for spousal maintenance. Obligor is more than thirty (30) days in , through , the amount paid was . ,
The obligor's full name is obligor's last known employer is obligor's last known address is City of obligor is not in the Armed Services. , State of
. The . The , in the . The
SPS103
State
ENG
4/08
www.mncourts.gov/forms
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All maintenance payments are payable to
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: (
)
SPS103
State
ENG
4/08
www.mncourts.gov/forms
Page 2 of 2