Free STATE OF MINNESOTA - Minnesota

State of Minnesota
County

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

Select County

Housing

Plaintiff/Petitioner

and
Defendant/Respondent

Affidavit of Personal Service

STATE OF MINNESOTA COUNTY OF
(County where Affidavit signed)

) ) SS ) , being sworn, state that I am at least

I,
(Name of person who hand-delivered documents)

18 years of age having been born on , upon the named defendant(s) by handing a true and correct copy of the documents to him/her at

, and that on , I served the attached Summons and Complaint ________________________
Name of defendant(s) (street address, city, state) .

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

HOU106

State

ENG

Rev 1/02-D

www.courts.state.mn.us/forms

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