CSX102 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(Name of person who served documents) (Date service made) attached documents, namely(Title of documents hand delivered or mailed)upon (check one): Petitioner (Name) Respondent (Name) County Attorney's Office (Name) Other (Name) by (check method of service used): (Address where documents delivered) .m. at o'clocknamed 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 namedat the Post Office located in the City of , State of at the person's last known address of: above by placing the document(s) in an envelope with sufficient postage in the United States mail 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 County and State where signed Name: Address: City/State/Zip: Telephone: E-mail address: American LegalNet, Inc. www.FormsWorkFlow.com