CSD703 State ENG Rev 7/15www.mncourts.gov/formsPage 1 of 2State of Minnesota District Court County of:Select County Judicial District: Court File Number: Case Type: Petitioner (first, middle, last)and Respondent (first, middle, last) Affidavit of Default of Child Support Judgment (Minn. Stat. 247 548.091, subd. 2a) , states that I am the Petitioner Respondent. According to the order dated , the obligor is to pay peras and for child support. Judgment was obtained by operation of law forunpaid child support as follows: Payment Due Date(s) Amount Due Amount Paid American LegalNet, Inc. www.FormsWorkFlow.com CSD703 State ENG Rev 7/15www.mncourts.gov/formsPage 2 of 2 The obligor's full name is . The obligor's last known employer is. The obligor's last known address is in the city of , State of. The obligor is not in the Armed Services. All child support payments are payable to 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