CSD101 State ENG Rev 7/15www.mncourts.gov/formsPage 1 of 1State of Minnesota District Court County of: Select County Judicial District: Court File Number: Case Type: Petitioner (first, middle, last)and Respondent (first, middle, last) In Re the Marriage of: Intervenor Affidavit of Personal Service Affidavit of Service by MailI, state that on I served the attached(Name of person who served documents) (Date of service) documents, namely(Title of documents hand delivered or mailed)upon (check one): Petitioner (Name) Respondent (Name) County Attorney's Office (Name) Other (Name) (Address where documents delivered) .m. at o'clock named above at Personally handing a true and correct copy of the document(s) to Mailing a true and correct copy of the document(s) to named above byplacing the document(s) in an envelope with sufficient postage in the United States mail at the Post Office located in the City of , State of at the person's last known address of: 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: Signature Name: Address: City/State/Zip: Telephone: E-mail address: American LegalNet, Inc. www.FormsWorkFlow.com