Minnesota > Statewide > District Court > Dissolution
Felony Notification Affidavit DIV-106 - Minnesota
| Felony Notification Affidavit Form. This is a Minnesota form and can be used in Dissolution District Court Statewide . |
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State of Minnesota County Judicial District: Court File Number: Case Type: District Court Dissolution In the Matter of the Application of: First Middle Last Felony Notification Affidavit For a change of name to: First Middle Last Application for Name Change Application for a Marriage License with Name Change Application for Name Change Pursuant to a Marriage Dissolution A notice pursuant to Minn. Stat. ยง259.13 was served upon the prosecuting authority that obtained the day of and which proof of service has been filed with the conviction on the court on the day of . If the prosecuting authority who obtained the conviction is from another state other than Minnesota or federal jurisdiction a notice was served also on the Minnesota Attorney General at 102 State Capitol day of Building, St. Paul, MN 55155 and which proof of service has been filed with the court on the . In reference to the above a period of 30 days has passed since notifying the prosecuting authority. A person who knowingly violates Minnesota Stat. 259.13 is guilty of a gross misdemeanor. Dated: Signature Name: Street Address City/State/Zip Telephone( ) (print) DIV106 State ENG Rev 12/01-D www.courts.state.mn.us/forms Page 1 of 1 American LegalNet, Inc. www.FormsWorkflow.com
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