STATE OF MINNESOTA DISTRICT COURT COUNTY OF DAKOTA FIRST JUDICIAL DISTRICT File # ____________________ _________________________ Petitioner VS. AFFIDAVIT OF DEFAULT OF MAINTENANCE JUDGMENT, AMOUNT DUE, AND IDENTIFICATION __________________________ Respondent ________________________________, being duly sworn on oath deposes and states that he/she is the petitioner/respondent (circle one). The full name of the judgment debtor/obligor is:______________________________________. The obligor’s last known employer is _______________________________________________. The obligor’s last known address is: ______________________________________, in the City of _______________________, State of _________________. The obligor’s last known post office address is ____________________________________. The obligor is not in the Armed Services. According to the court order dated _________________, the obligor is to pay $__________per _________, as and for maintenance . Judgment was obtained by operation of law for unpaid maintenance as follows: Amount Paid Amount Unpaid Payment Due Date (s) __________________ ___________ ______________ __________________ ___________ ______________ __________________ ___________ ______________ __________________ ___________ ______________ __________________ ___________ ______________ __________________ ___________ ______________ __________________ ___________ ______________ __________________ ___________ ______________ Total Amount Unpaid: $_______________________ _____________________________ (Signature) Subscribed and sworn before me on this ____________day of________, 20__ _________________________________ Notary Public American LegalNet, Inc. www.FormsWorkflow.com STATE OF MINNESOTA COUNTY OF DAKOTA DISTRICT COURT FIRST JUDICIAL DISTRICT File # ____________________ _________________________ Petitioner VS. NOTICE OF ENTRY AND DOCKETING OF MAINTENANCE JUDGMENT __________________________ Respondent TO:________________________THE ABOVE NAMED_________________OBLIGOR: (Petitioner or Respondent) You are hereby notified pursuant to Minnesota Statute 548.091 that you have twenty (20) days from the date of this notice to either pay all amounts claimed unpaid in the attached Affidavit of Default or to request a court hearing on the issue of whether the amounts claimed owing have been paid and to seek, ex parte, a stay of entry of judgment and serve a copy of your Notice of Motion and Motions on _______________________. Should you fail to do either of the above, judgment will be entered and docketed against you in the amount of $____________. Dated:________________________ _________________________ Signature ______________________________ Print Name ______________________________ Address ______________________________ City, State, Zip ______________________________ Telephone Subscribed and sworn before me This _____day of ________, 20__ ____________________________ Notary Public American LegalNet, Inc. www.FormsWorkflow.com