Request For Drivers License Suspension And Affidavit

STATE OF MINNESOTA COUNTY OF HENNEPIN FOURTH JUDICIAL DISTRICT DISTRICT COURT _______________________________ _______________________________ Plaintiff AFFIDAVIT OF IDENTIFICATION AND OF UNSATISFIED CIVIL JUDGMENT -vs- _______________________________ _______________________________ Defendant Case No. ____________________________ ___________________________________________, being first duly sworn, states that (s)he is the judgment creditor in the above-entitled case; that the judgment in the above-entitled case has not been satisfied within the 30 days allowed by statute; and that to the best of my knowledge, the following information is true and correct. JUDGMENT DEBTOR NAME ______________________________________________________________ (first) (street) (city) (middle) (state) (last) (zip) JUDGMENT DEBTOR ADDRESS ___________________________________________________________ DEBTOR DRIVER LICENSE _______________________________ DATE OF BIRTH ______________ DEBTOR VEHICLE LICENSE NUMBER ______________________ DATE OF ACCIDENT __________ PLACE OF ACCIDENT ____________________________________________________________________ (streets) (city) (state) Subscribed and sworn to before me on ___________________, 20___. _____________________________ Court Clerk or Notary _______________________________________ Signature of Judgment Creditor or Attorney _______________________________________ (address) ____________________________________ City, State, Zip DO NOT WRITE BELOW THIS LINE-FOR OFFICE USE ONLY __________________________________________________________________________________ I certify that the above is a true and correct transcript of the final judgment which was entered on ________________, becoming final on ______________________, in the amount of $_________________, 30 days having expired, no appeal having been taken, judgment remains unsatisfied. Date _____________________ ____________________________________ Court Clerk, Hennepin County District Court __________________________________________________________________________________ I certify that the above judgment has been satisfied in full and a statement of satisfaction filed with this Court on: _______________________. Date: _________________ ____________________________________ Court Clerk, Hennepin County District Court Affidavit Unsatisfied Civil Judgment Last Revision 7/11/02 American LegalNet, Inc. www.FormsWorkFlow.com