State of Minnesota
County
District Court
Judicial District: Court File Number: Case Type: Juvenile
Select County
In the Matter of the Welfare of the Child(ren) of:
Certificate of Representation
Parent Parent Legal Custodian Legal Custodian
CERTIFICATE OF REPRESENTATION This certificate must be filed pursuant to Rule 25.05 of the Rules of Juvenile Protection Procedure, which states: "An attorney representing a client in a juvenile protection matter, other than a public defender or county attorney, shall on or before the attorney's first appearance file a certificate of representation."
________________________________ Name of Party Represented by Attorney ________________________________ Atty Name (Not firm name) _________________________________ Address _________________________________ _________________________________ _________________________________ Phone Number _________________________________ MN Atty ID No.
CHP101
State
ENG
Rev 3/04-D
www.courts.state.mn.us/forms
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