Free STATE OF MINNESOTA - Minnesota

State of Minnesota
County

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

Select County
In Re the Marriage of:

Name of Petitioner and

Affidavit of Service by Mail Pursuant to Court Order
Minn. Stat. §518.11(c)

Name of Respondent

STATE OF MINNESOTA COUNTY OF (County where Affidavit signed)

) ) SS )

I, (Name of person who mailed documents) state I am at least 18 years old, that on attached Summons and Petition upon

, being sworn/affirmed, upon oath, (date), I served the (Full name of by placing a

other party) based on the Order for Service by Alternate Means dated

true and correct copy of each document in an envelope marked "forwarding address requested" and addressed to: , State of in the City of , Zip Code and depositing the envelope City of .

with sufficient first class postage in the United State Mail at the Post Office located in the in the State of

Dated:
Signature (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

DIV1304

State

ENG

Rev 6/05-D

www.courts.state.mn.us/forms

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