CSD102 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)andIn the Matter of: Respondent (first, middle, last)Notice of Intent to Recover Attorney Fees and Collection CostsTo the Above Named:You are hereby notified pursuant to Minn. Stat. 247518A.735, that (obligee) intends to recover attorney fees andcollection costs incurred to collect the child support judgment(s) docketed against you on the date(s) and in the amount(s) shown below. Please take further notice that you have 20 days from the date of this notice to request a hearing on the issue of whether the fees and costs itemized below are reasonable or to contest the child support judgment based upon mistake of fact (e.g., whether the amounts shown below are correct, whether you were a party to the original judgment, and etc.). If you fail to request a hearing, the fees and costs will become an additional judgment against you for child support. The amount of attorney fees and collection costs sought by the obligee are as follows: (Attorney Fees) (Collection Costs) Total Fees and CostsJudgment(s) for which costs and fees incurred: Docketed Date Docketed Amount Balance Due (Includes Accrued Interest) Dated: Signature Name: Address: City/State/Zip: Telephone: E-mail address: American LegalNet, Inc. www.FormsWorkFlow.com