CHP405 State ENG Rev 11/18 www.mncourts.gov/forms Page 1 of 2 State of Minnesota District Court County Judicial District: Court File Number: Case Type: Juvenile In the Matter of the Welfare of the Child(ren) of: Affidavit of Service: Notice of Intervention as a Party as a Matter of Right Parent Legal Cu s todian Parent Legal Cu s todian I, , state that on , I served the (Name of person who mailed or hand delivered documents) (Date service made) Notice of Intervention as a Party as a Matter of Right by (check one): Hand-delivering the document; OR Mailing the document to the following person(s) at the following addresses: 1. First Middle Last Street Address Apt. No. City County State and Zip 2 . First Middle Last Street Address Apt. No. City County State and Zip 3 . First Middle Last Street Address Apt. No. City County State and Zip 4 . First Middle Last American LegalNet, Inc. www.FormsWorkFlow.com CHP405 State ENG Rev 11/18 www.mncourts.gov/forms Page 2 of 2 Street Address Apt. No. City County State and Zip 5 . First Middle Last Street Address Apt. No. City County State and Zip 6 . First Middle Last Street Address Apt. No. City County State and Zip 7 . First Middle Last Street Address Apt. No. City County State and Zip 8 . First Middle Last Street Address Apt. No. City County State and Zip I declare under penalty of perjury that everything I have stated in this document is true and correct. Minn. Stat. 247 358.116 Dated Signature Name: Address: County and state where signed City/State/Zip: Telephone: Email: American LegalNet, Inc. www.FormsWorkFlow.com