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ADA Accomodation Request Form - Minnesota

ADA Accomodation Request Form Form. This is a Minnesota form and can be used in General District Court Hennepin Local County .
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ADA Accommodation Request Form To ask the 4th District Court for an accommodation under the Americans with Disabilities Act (ADA), please print this form and fill it out. Send or bring the completed form to the 4th District Human Resources Division, 300 S. 6th Street, #C-12, Minneapolis, MN 55487 (Fax # 612-348-6736), at least 10 business days ahead of the date the accommodation is needed. Today's date: Date(s) the accommodation is needed: Courthouse where accommodation is needed: Case or Court File Number or name of case, if known: Name of person needing the accommodation: Address (number, street, apartment, city, state, zip code): Telephone number: Email (Optional): Person who needs accommodation is: (check at least one) Attorney Petitioner Other (Specify): Defendant Respondent Job Applicant Witness Juror Victim Plaintiff Type of Court Case: (check one) Civil Juvenile Criminal Probate Conciliation Court (small claims) Other (Specify): Family Please describe the disability that makes an accommodation necessary. What specific accommodation is requested? Is there anything else about the disability or accommodation that you would like court to know? If you need more room, you can attach more pages. American LegalNet, Inc. www.FormsWorkFlow.com Rev. 09/2012 www.mncourts.gov/district/4
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