State of Minnesota County Judicial District: Court File Number: Case Type: Juvenile District Court In the Matter of the Welfare of the Child(ren) of: Parent Parent Legal Custodian Legal Custodian Certificate of Representation CERTIFICATE OF REPRESENTATION This certificate must be filed pursuant to Rule 25.05 of the Rules of Juvenile Protection Procedure, which states: "An attorney representing a client in a juvenile protection matter, other than a public defender or county attorney, shall on or before the attorney's first appearance file a certificate of representation." ________________________________ Name of Party Represented by Attorney ________________________________ Atty Name (Not firm name) _________________________________ Address _________________________________ City / State / Zip _________________________________ Phone Number _________________________________ E-mail address _________________________________ MN Atty ID No. CHP101 State ENG Rev 7/15 www.mncourts.gov/forms Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com