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This is a Minnesota form that can be used for Dissolution within Statewide, District Court.
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State of Minnesota County Judicial District: Court File Number: Case Type: District Court Dissolution without Children In Re the Marriage of: Name of Petitioner and Name of Respondent Affidavit of Service by Mail STATE OF MINNESOTA COUNTY OF I, age having been born on ) ) SS ) , state that I am at least 18 years of , and that on (County where Affidavit signed) , I served the following papers: (list all papers mailed to the other party) by placing in an envelope a true and correct copy of each document addressed to at , State of , Zip Code in the City of and depositing the envelope, with sufficient postage, in the United States Mail at the Post Office located in the City of in the State of . I declare under penalty of perjury that everything I have stated in this document is true and correct. Minn. Stat. § 358.116. Dated: Signature of Person Who Mailed Documents Name: Address: City/State/Zip: Telephone: ( E-mail address: American LegalNet, Inc. www.FormsWorkFlow.com ) DIV504 State ENG Rev 7/15 www.mncourts.gov/forms Page 1 of 1
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