DIV1304 State ENG Rev 10/17www.mncourts.gov/formsPage 1 of 1State of Minnesota District Court County of: Select County Judicial District: Court File Number: Case Type: Dissolution In Re the Marriage of: Petitioner(first, middle, last)vs. Respondent (first, middle, last)Affidavit of Service by Mail Pursuant to Court Order Minn. Stat. 247518.11 ( c )I, , state that I am at least 18 years old, and that on (date), I served the attached Summons and Petition upon (Full name of other party) based on the Order for Service by Alternate Means datedby placing a true and correct copy of each document in an envelope marked "forwarding address requested" and addressed to in the City of State of , Zip Codeand depositing the envelope, with sufficient first class postage in the United States Mail at the Post Office located in the City of in the State of.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