Form Div805 - Admission Of Service Of Summons And Petition For Dissolution Of Marriage Page 2
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1
2State of Minnesota
District Court
County
Judicial District:
Court File Number:
Case Type:
Dissolution with Children
In the Matter of:
Petitioner
Affidavit of Personal Service
and
Respondent
STATE OF MINNESOTA
)
) SS
COUNTY OF
)
(County where Affidavit signed)
I,
, being sworn, state that I am at least 18 years of age
(Name of person who hand-delivered documents)
having been born on
, and that on
,
I served the Summons and Petition for Dissolution of Marriage upon
(Name of other party)
by handing a true and correct copy of the documents to
him/her at:
street address
city
state
Signature of Person who Served the Documents
Dated:
Signature (Sign only in front of notary public or court administrator.)
Name:
Sworn/affirmed before me this
Address:
day of
,
.
City/State/Zip:
Telephone: (
)
Notary Public \ Deputy Court Administrator
DIV805
State
ENG
Rev 11/01-D
Page 2 of 2
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