DIV1403 State ENG Rev 10/17www.mncourts.gov/formsPage 1 of 3State of Minnesota District Court County of:Select County Judicial District: Court File Number: Case Type: Dissolution Name of Petitioner (first, middle, last) Name of Respondent (first, middle, last) andIn Re the Marriage of:Affidavit in Support of Motion For Contempt of Court 1. My true and correct name is and I state that the information contained in this Affidavit is true and correct to the best of my knowledge.2. I am the (check one): Petitioner Respondent in the above-entitled matter, and Imake this Affidavit in support of my contempt motion. 3. The person that should be held in contempt is:4. The Judgment and Decree or Order that I wish to enforce by this contempt motion is dated (month, day, year). A copy is attached to this Affidavit as Exhibit"A" . (Attach a copy of the Judgment and Decree or Order and mark it as Exhibit "A". If there is more than one Judgment and Decree or Order, mark the second as Exhibit "B", etc.)5. The particular paragraphs of the Decree or Order attached hereto as Exhibit "A" that are not being followed by the other party are: (list each page and paragraph number) The particular paragraphs of the Decree or Order hereto as Exhibit "B" that are not being followed by the other party are: (list each page and paragraph number) 6. On (month, day, year) , the other party was served with a copy of the Judgment and Decree or Order for which (s)he should be held in contempt. As evidence of service, I have attached to this Affidavit in Support of Motion one of the following: (check one for each Decree or Order you attached as an Exhibit, and on the blank line write in the Exhibit letter of the Decree or Order to which the evidence of service relates) Affidavit of Service (attach copy) Admission of Service (attach copy) Signature of other party on the face of the Judgment and Decree or Order, acknowledging American LegalNet, Inc. www.FormsWorkFlow.com DIV1403 State ENG Rev 10/17www.mncourts.gov/formsPage 2 of 3receipt of a copy * If you are seeking contempt for non-payment of CHILD SUPPORT, fill out numbers 7-9.7. Monthly child support in the amount of was supposed to be paid,but was not paid during the following months: (fill in month/year - for example, "3/10") 8. In addition to the months when no child support was paid, only a partial payment was made during the following month: (fill in month/year and the amount - for example, "3/10 received $125.00") 9. The total amount of unpaid child support is .* If you are seeking contempt for non-payment of SPOUSAL MAINTENANCE, fill out numbers 10-12.10. Monthly maintenance in the amount of was supposed to be paid,but was not paid during the following months: (fill in month/year - for example, "3/10") 11. In addition to the months when no maintenance was paid, only a partial payment was made during the following months: (fill in month/year and the amount - for example, "3/10 received $125.00") 12. The total amount of unpaid maintenance is for the period (datemaintenance was first due) through (date maintenance last due) 13. I was awarded the following property that has not been returned to me (list the items and paragraphs wherein the items were awarded to you. For example, "Television, paragraph17." 14. I last saw this property on (month, day, year) when it was located at(fill in address) 15. I know that the property is now located at (fill in the address): because (explain how you know this) ***If you are seeking contempt for interference with your PARENTING TIME fill out the following with respect to EACH parenting time/ day that you claim was denied. American LegalNet, Inc. www.FormsWorkFlow.com DIV1403 State ENG Rev 10/17www.mncourts.gov/formsPage 3 of 316.I did not have parenting time on the following days and I was denied parenting timebecause the parent with physical custody did the following (fill in each day and reason why you were denied parenting time. For example "2/1/10 - The other party failed to drop off the children as ordered.") ***If you are seeking contempt for some reason other than for non-payment of child support or spousal maintenance, failure to return property, or denial of parenting time, fill out number 17.17.The other party was ordered to do the following but has not done it yet (describe what wasordered to be done and list the paragraph numbers of the Judgment and Decree or Order that required it to be done.) Signature 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: County and State where signed Name: Address: City/State/Zip: Telephone: E-mail address: American LegalNet, Inc. www.FormsWorkFlow.com