Free STATE OF MINNESOTA - Minnesota

State of Minnesota
County
Select County

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

Dissolution with Children

In Re the Marriage of:
Name of Petitioner

and
Name of Respondent

Affidavit of Service by Mail

STATE OF MINNESOTA COUNTY OF

) ) SS )

(County where Affidavit signed)

I, 18 years of age having been born on , , I served the following papers:
(list all papers mailed to the other party)

, being sworn, state that I am at least , and that on

by placing in an envelope a true and correct copy of each document addressed to at , State of , Zip Code in the City of and depositing the

envelope, with sufficient postage, in the United States Mail at the Post Office located in the City of in the State of .

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

Name: Sworn/affirmed before me this day of , . Address: City/State/Zip: Telephone:
Notary Public \ Deputy Court Administrator

DIV904

State

ENG

Rev 1/02-D

www.courts.state.mn.us/forms

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