State of Minnesota District Court County Judicial District: Court File Number: Case Type: Housing Plaintiff (Tenant) Counterclaim For Possession of Premises and Notice of Hearing (Minn. Stat. §504B.385, subd. 2) vs. Defendant (Landlord) STATE OF MINNESOTA ) ) SS ) COUNTY OF NOTICE TO TENANT: Your landlord is asking the court to evict you. I, am the: (check one)  Landlord (Name)  Person with power of authority filed and state: by an  oral 1. Landlord leased or rented to tenant(s) on written Date agreement the premises at: Street Apt. City The agreement was from rent to State Zip Code . The current due and payable under this agreement each month is $ due on the Amount Date day of each month. Tenant(s) date(s) of Birth: (if known) 2. The landlord of the premises described above is 3. The plaintiff is still in possession of the premises. 4. Plaintiff(s) filed a rent escrow action and deposited with the Court $ (“none” or $ amount) 5. Plaintiff(s) failed to deposit the full amount of rent due and owing on the date of the deposit. HOU402 State ENG Rev 7/15 www.mncourts.gov/forms Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com On the date of the deposit with the court, plaintiff(s) owed a total of $ in rent as follows: $ per month due for months. 6. Defendant, having the present right of possession of the property, has complied with Minn. Stat. §504B.181 by:  a. disclosing to tenant either in rental agreement or otherwise in writing prior to the start of the tenancy the name and address of: 1. the person authorized to manage the property; AND 2. the landlord or agent authorized by landlord to accept service of process and receive and give receipt for notices and demands; AND  b. posting in a conspicuous place on the property a printed or typewritten notice containing the above information (describe where posted) _____________________________________________________________________ _____________________________________________________________________ OR  c. the above information was known by tenant(s) not less than 30 days before the filing of this action because: _____________________________________________________________________ _____________________________________________________________________ 7. The defendant seeks judgment against the plaintiff(s) for restitution of the premises plus costs and disbursements. I declare under penalty of perjury that everything I have stated in this document is true and correct. Minn. Stat. § 358.116. Dated: Signature Name: Address: City/State/Zip: Telephone: ( ) E-mail address: HOU402 State ENG Rev 7/15 www.mncourts.gov/forms Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com HEARING DATE: IMPORTANT NOTICE TO PARTIES TENANT: You must appear before the court or you could be evicted. _______ The Rent Escrow Hearing, previously set for ___________________________ is continued and consolidated with the counterclaim and will be heard on _____________, at Date _______________________, ______________________________________________________ Time Location OR _____ The Rent Escrow Hearing and counterclaim are consolidated and will be heard on __________________, at __________, _____________________________________________. Date Time Location Note: Landlord is responsible for having a third party serve a copy of this Counterclaim on tenants(s) at least 7 days before the hearing date. Service must be made in the manner specified in Minn. Stat. §504B.331. See Minn. Stat. §504B.385, subd. 2(d). HOU402 State ENG Rev 7/15 www.mncourts.gov/forms Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com