Free DOMESTIC ABUSE - Minnesota

State of Minnesota
County
Select County

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

In the Matter of:
Petitioner

Notice of Change of Address (Minn. Stat. § 518B.01)
vs.

Respondent

I, place of residence from that of:

, the above named (Petitioner) (Respondent), changed my permanent

to:

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

Notice of Change of Address
You are hereby notified that Petitioner/Respondent in the above named action has changed address, as indicated above. If Petitioner changed residence, a copy of this notice shall be filed with the District Court. Upon Petitioner's request, Petitioner's address shall be confidential. A copy of this notice shall be mailed with a copy of the original order to the Police Department having jurisdiction over Petitioner's new residence.

Date: Court Administrator/Deputy

OFP801

State

ENG

Rev 5/01

www.mncourts.gov/forms

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