HOU402 State ENG Rev 7/15www.mncourts.gov/formsPage 1 of 3State of Minnesota District Court County of: Select County Judicial District: Case Type: Housing Court File Number: Plaintiff (Tenant) (first, middle, last)vs. Defendant (Landlord) (first, middle, last)Counterclaim for Possession of Premises and Notice of Hearing (Minn. Stat. 247504.385, subd. 2)NOTICE TO TENANT: Your landlord is asking the court to evict you. I, am the: (check one) Landlord Person with power ofauthority filed and state:1. Landlord leased or rented to tenant(s) on by an oral written agreement the premises at: Street Apt City State Zip Code The agreement was from to . The current rent due and payable under this agreement each month is $ due on the day of each month. Tenant(s) date(s) of Birth: (if known) 2. The landlord of the premises described above is:3. The plaintiff is still in possession of the premises.4. Plaintiff(s) filed a rent escrow action and deposited with the Court $ ("none" or $ amount)5. Plaintiff(s) failed to deposit the full amount of rent due and owing on the date of the deposit. On the date of the deposit with the court, plaintiff(s) owed a total of $ in rent as follows: $ per month due for months.6. Defendant, having the present right of possession of the proerpty, has complied with Minn. Stat. 247504B.181 by: a. disclosing to tenant either in rental agreement or otherwise in writing prior to the start American LegalNet, Inc. www.FormsWorkFlow.com HOU402 State ENG Rev 7/15www.mncourts.gov/formsPage 2 of 3of the tenancy the name and address of: 1.the person authorized to manage the property; AND2.the landlord or agent authorized by landlord to accept service of process and receiveand give receipt for notices and demands; AND b.posting in a conspicuous place on the property a printed or typewritten noticecontaining the above information (describe where posted) OR c.the above information was known by tenant(s) not less than 30 days before the filingof this action because: 7.The defendant seeks judgment against the plaintiff(s) for restitution of the premises pluscosts and disbursements. Signature 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: County and State where signed Name: Address: City/State/Zip: Telephone: E-mail address: American LegalNet, Inc. www.FormsWorkFlow.com HOU402 State ENG Rev 7/15www.mncourts.gov/formsPage 3 of 3 HEARING DATE: IMPORTANT NOTICE TO PARTIES TENANT: You must appear before the court or you could be evicted. (Check one) The Rent Escrow Hearing, previously set for is continuedand consolidated with the counterclaim and will be heard on at (Date) , (Time) (Location)OR The Rent Escrow Hearing and counterclaim are consolidated and will be heard on at , (Date) (Time) (Location)Note: Landlord is responsible for having a third party serve a copy of this Counterclaim on tenants(s) at least 7 days before the hearing date. Service must be made in the manner specified in Minn. Stat. 247504B.331. See Minn. Stat. 247504B.385, subd. 2(d). American LegalNet, Inc. www.FormsWorkFlow.com