State of Minnesota
County
Select County
In the Matter of:
Petitioner
District Court
Judicial District: Court File Number: Case Type: Domestic Abuse
vs.
Affidavit and Order to Show Cause for Contempt (Minn. Stat. ยง 518B.01)
Respondent
STATE OF MINNESOTA
) ) ss. COUNTY OF ___________________)
(County where Affidavit signed)
I, (Petitioner)(Peace Officer) (Other interested party designated by the Court) being sworn/affirmed on oath state that Respondent violated the following provisions of the Restraining Order dated . (List provisions of the Order that Respondent violated.)
These provisions were violated when Respondent committed the following acts (Describe specific acts including what happened, who was involved and approximate dates. List the most recent dates first. Add additional sheets if necessary.)
Dated:
Signature (Sign only in front of notary public or court administrator.)
Subscribed and sworn to before me this day of , .
Name: Address: City/State/Zip:
Notary Public \ Deputy Court Administrator OFP301 State ENG
Telephone:
Rev 8/08 www.mncourts.gov/forms Page 1 of 2
Order
TO: , the Respondent:
Based on the Affidavit and all of the records and proceedings in this matter, YOU ARE ORDERED to appear at on
(Address) (Date)
at
(Time)
.m. and explain why you should not be found in Contempt of Court for violating the .
Order for Protection dated
It is further ordered that the appropriate law enforcement agency shall help Petitioner execute and / or serve this Order, without charge.
Note: All responsive pleadings shall be served and mailed to or filed with the court administrator no later than five days prior to the scheduled hearing. The Court may, in its discretion, disregard any responsive pleadings served or filed with the court administrator less than five days prior to such hearing in ruling on the motion or matter in question.
If you do not appear, the court may hold you in contempt of court, and may issue a warrant for your arrest.
Dated:. Judge of District Court NOTE: Bring witnesses and any supporting documentation to the hearing. Distribution
______ Certified copy or original - Return to Court Administrator with Affidavit of Personal Service attached Copy for Petitioner(s) Copy for Respondent(s) Copy for file until original returned Copy for local police department Copy for Sheriff Other: ______ Dissolution File
OFP301
State
ENG
Rev 8/08
www.mncourts.gov/forms
Page 2 of 2