OFP503 State ENG Rev 8/18www.mncourts.gov/formsPage 1 of 2State of Minnesota District Court County of: Select County Judicial District: Court File Number: Case Type: Domestic Abuse Petitioner (first, middle, last) Respondent (first, middle, last)andAffidavit for Filing Foreign Protective Order I, , am the person filing a foreign protectiveorder pursuant to Minn. Stat. 247 518B.01, subd 19a. I further state my belief that the foreign protective order filed with this affidavit is a valid order and has not been amended, rescinded, or superseded by any orders from a court of competent jurisdiction.The information below assists with entry of foreign protective orders under Minn. Stat. 247 518B.01, subd 19a. Please complete as much information as possible to ensure that the conditions intended by the issuing court are reflected in the Minnesota Court Information System and the correct information passes to law enforcement. Party / Protected Person Information Petitioner Check for confidential address/phone number Name: Date of Birth (or age): Gender: Race:Petitioner is Protected Party? Yes NoAddress:(If your address is confidential do not include it here)Phone Number(s): (If your phone number is confidential do not include it here) Respondent Name: Date of Birth (or age): Gender: Race:Address: Phone Number(s): American LegalNet, Inc. www.FormsWorkFlow.com OFP503 State ENG Rev 8/18www.mncourts.gov/formsPage 2 of 2 Other Persons Protected by Order Name: Date of Birth (or age): Gender: Race: Name: Date of Birth (or age): Gender: Race:(attach additional sheet with additional names and protected addresses if necessary) Parties' Qualifying Relationship Married Divorced Living Together Lived Together Have Unborn Child Together Have a Child Together Related by Blood Significant Romantic or Sexual Relationship Parent and Child Information about the Order Issuing Court: Issue Date:Service Information Order Expiration Date: Servicing Agency: Date Served:Type of Service: In Person By Mail By Short Form By PublicationI understand that requests for modification, dismissal, or extension of the order must be addressed in the court that issued the original order. I understand that I am responsible for filing any updates to this order, including service information and any order changes, dismissals, or extensions, etc., with the same county court administrator for entry into the Minnesota Court Information System. Not coming back to the same county court to file changes and update information may delay or prevent enforcement of this order. 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 /s/ Name: Address: City/State/Zip: Telephone: E-mail address: County and State where signed American LegalNet, Inc. www.FormsWorkFlow.com