State of Minnesota County Judicial District: Court File Number: Case Type: District Court Civil Demand for Judicial Determination of Forfeiture of Motor Vehicle (Minn. Stat. §169A.63, subd. 8) (Name) (Address) (City/State) (Telephone) (Zip Code) Plaintiff/Claimant (Vehicle Seized-Year, Make, Model) vs. (VIN #) (Plate # ) Defendant To: __________________________________________________________________ (list the prosecuting authority that initiated the forfeiture) STATE OF MINNESOTA COUNTY OF ) ) SS ) Complaint: The plaintiff/claimant in this matter asks for a judicial decision on the forfeiture of the defendant motor vehicle pursuant to Minn. Stat. §169A.63 claiming the vehicle was improperly seized for the following reasons: (Specify why you are making this claim and your interest in the vehicle seized. Use additional sheet(s) if necessary.) 1. 2. FOR202 State ENG Rev 7/15 www.mncourts.state/forms Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 3. I declare under penalty of perjury that everything I have stated in this document is true and correct. Minn. Stat. § 358.116. Dated: Signature Name: Address: City/State/Zip: Telephone: ( E-mail address: ) FOR202 State ENG Rev 7/15 www.mncourts.state/forms Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com