Free State of Minnesota - Minnesota

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Affidavit of Service
STATE OF MINNESOTA COUNTY OF
(County where Affidavit Signed)

) ) (Name of person who mailed the documents), , I

I,

being duly sworn upon oath, state that I am at least 18 years of age; that on

served the attached documents (Notice of Hearing and Petition for Expungement and Proposed Order) by mailing a true and correct copy to the following parties at the following addresses by placing the documents in the U.S. mail in the city of Minnesota Attorney General Public Safety/Gambling Division 1800 NCL Tower, 445 Minnesota St St Paul MN 55101-2134 with sufficient postage: Bureau of Criminal Apprehension Attn: Records Department 1430 Maryland Ave E St Paul, MN 55106

Dated: Signature Sworn/affirmed before me this (Date):
(Sign only in presence of notary or Court Deputy)

Print Name: Address: City/State/Zip:

Notary Public/Deputy Court Administrator

Telephone:

EXP104

State

ENG

Rev 12/03

www.courts.state.mn.us/forms

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