State Of Minnesota District Court - Certificate Of Representation And Parties Page 2
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1
2PLAINTIFF/PETITIONER, Self-represented
DEFENDANT/RESPONDENT, Self-represented
Name
Name
Postal Address
Postal Address
City
State
Zip Code
City
State
Zip Code
Telephone Number
Telephone Number
E-mail address
E-mail address
(Attach additional sheets for additional attorneys / parties)
Note: If either Plaintiff/Petitioner or Defendant/Respondent gets an attorney, the attorney’s
name, address, telephone number and attorney ID number must be given in writing to the Court
Administrator immediately.
CIV102
State
ENG
Rev 05/13
Page 2 of 2
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