CSX1103 State ENG Rev 4/18www.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) In Re the Marriage of: Intervenor Affidavit in Support of Motion to Stop Cost of Living AdjustmentI, , state the following:1.I am the Petitioner Respondentin this action:2.I am employed by: a.Employer: b.Address: c.Work telephone number: d.Occupation/Type of work: e.Length of Employment: f.Supervisor: g.Gross Pay:h.Paid: Weekly Every other week Twice a month Monthly 3.I was previously employed by foryears.4.I have the following additional sources of income: Source: per month Source: per month Source: per month American LegalNet, Inc. www.FormsWorkFlow.com CSX1103 State ENG Rev 4/18www.mncourts.gov/formsPage 2 of 25.There has not been a sufficient cost-of-living or other increase in my income to allow foran adjustment in my child support.6.Copies of my tax returns and any other documentation of my income for the past threeyears, , and is provided to the other party in thisaction and the county attorney as an attachment and provided to the CourtAdministrator.7.I am submitting this affidavit in support of my motion to stop the cost-of-livingadjustment.I declare under penalty of perjury that everything 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