HOU106 State ENG Rev 7/15www.mncourts.gov/formsPage 1 of 1State of Minnesota District Court County of: Select County Judicial District: Court File Number: Case Type: Housing Plaintiff (first, middle, last) vs. Defendant (first, middle, last) Hearing Date: Time:Affidavit of Service by Mail I, state that on (Name of person who hand-delivered documents) (Date documents mailed)I served a Summons and Complaint in an Eviction action upon (name of person(s) to whom documents were mailed) by placing a true and correct copy of the document in an envelope addressed to the persons at his/her last known address of in the City of , State of Minnesota, and whose Zip Code is , and depositing the envelope, with sufficient postage in the U.S. Mail at the Post office located in the City of, State of Minnesota.I declare under penalty of perjury that everything that I have stated in this document is true and correct. Minn. Stat. 247 358.116. Dated: Signature County and State where signed Name: Address: City/State/Zip: Telephone: E-mail address: American LegalNet, Inc. www.FormsWorkFlow.com