Minnesota > Statewide > District Court > Child Support
Affidavit Of Facsimile Service CSX-101 - Minnesota
| Affidavit Of Facsimile Service Form. This is a Minnesota form and can be used in Child Support District Court Statewide . |
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State of Minnesota County District Court Judicial District: Court File Number: Case Type: In Re the Marriage of: Plaintiff / Petitioner vs / and Defendant / Respondent Intervenor STATE OF MINNESOTA ) COUNTY OF ____________________ ) SS (County where Affidavit Signed) Affidavit of Facsimile Service I, (Name of person who faxed documents) , state that on (Date documents faxed) at ____ o'clock ___.m. at (Place documents faxed from) served the attached , by faxing a true and (Title of documents faxed) documents, namely correct copy of the document(s) addressed to his/her fax number ( ) , in the city of (Fax number of person to whom documents were faxed) upon (check all that apply): State of Plaintiff / Petitioner (Name) Defendant / Respondent (Name) County Agency (Name) Other (Name) Dated: listed below at Signature ( Sign only in presence of Notary or Court Deputy) Print Name: Sworn / affirmed before me this day of , Address: City/State/Zip: Telephone: ( Notary Public/ Deputy Court Administrator ) CSX101 State ENG Rev 8/05-D www.courts.state.mn.us/forms Page 1 of 1 American LegalNet, Inc. www.FormsWorkflow.com
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