CIV112 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: Other Civil Petitioner (first, middle, last) Respondent Commissioner of Public Safetyvs.Affidavit of ServiceI, , state that I am at least 18 years of age (Name of person who mailed documents)having been born on , and that on I served the (date) (date)attached documents: Petition for Court Hearing for Reinstatement of Driver's License upon the Commissioner of Public Safety, the respondent in this action, by mailing a true and correct copy of the documents by first class U.S. mail addressed as follows:Minnesota Attorney General Commissioner of Public Safety 445 Minnesota Street, Suite 1800 St. Paul, MN 55101I 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: County and State where signed American LegalNet, Inc. www.FormsWorkFlow.com