CSX2503 State ENG Rev 8/16www.mncourts.gov/formsPage 1 of 1State of Minnesota District Court County of:Select County Judicial District: Court File Number: Case Type: In Re the Marriage of: Petitioner (first, middle, last) and Respondent (first, middle, last) Intervenor Affidavit in Support of Motion to Reinstate Recreational License(s) I, , state the following reasonswhy an order reinstating my recreational license(s) should be granted. Check one of the statements below that apply: I have never entered into a written payment agreement and request that the court establish a payment agreement pursuant to Minn. Stat. 247 518A.69. I have signed a written payment agreement and am in compliance with all written payment agreements pursuant to Minn. Stat. 247 518A.69. This includes payments in full of all arrears. I have signed a written payment agreement but request that the court make changes to the payment agreement by taking into consideration my circumstances described briefly below. 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