HOU602 State ENG Rev 7/15www.mncourts.gov/formsPage 1 of 4State of Minnesota District Court County of: Select County Judicial District: Court File Number: Case Type: Housing Name of Plaintiff(s)/Tenant(s) vs. Name of Defendant(s)/Building Owner(s)Petition for Emergency Relief Under Tenant Remedies Act (Minn. Stat. 247 504B.381) My name is, I understand that I must tell the truth when answering the following questions:1. I am a tenant with the right to live at the property located at the following address: Address: Street Address Apt. or Unit Number City/St./Zip: City State Zip Code County:Select County Phone:2. The name, address, and phone number for the owners(s) of the property are: Name: Address: Street Address Apt. No. City/State/Zip Code Phone:3. The name, address, and phone number for the managers(s) of the property (if different from the owner) are: Name: Address: Street Address Apt. No. City/State/Zip Code Phone: American LegalNet, Inc. www.FormsWorkFlow.com HOU602 State ENG Rev 7/15www.mncourts.gov/formsPage 2 of 44. I am requesting emergency relief from the court because of a loss of one or more of the following utilities, facilities, or other essential services that the building owner and manager are responsible for providing (check all that apply): heat running water hot water electricity sanitary facilities other 5. The following facts show that I have an emergency caused by the loss of utilities, facilities, or other essential services that the building owner and manager are responsible for providing (tell the court what the emergency is and why the owner and manager are responsible for providing that utility or service): 6. On the following date:, I reported this emergency to: I have taken the following actions to report this emergency (tell the court HOW you told or tried to tell the building owner or manager about the problem and WHAT you told the person about the problem): 7. The building owner or manager did not fix the emergency problem. 8. On the following date: I gavewho is the owner and/or manager a twenty four hour notice that I would be requesting emergency relief from the Court today by (tell the court HOW you told or tried to tell the building owner or manager that you were going to court and what you told the person if you talked to the person or left a message): 9. This emergency problem is not the result of a deliberate or negligent act or omission by me or anyone acting under my direction or control. (Check box if this applies) 10. The following other information would be helpful to the Court in granting emergency relief (tell the court any other information regarding this emergency that you think will be helpful to the court in granting your request for help): 11. I am asking the Court to order one or more of the following: Direct the building owner or manager to immediately fix the emergency problems with my housing. Allow me to fix the emergency problems with my housing and deduct the costs from my rent. American LegalNet, Inc. www.FormsWorkFlow.com HOU602 State ENG Rev 7/15www.mncourts.gov/formsPage 3 of 4 Direct that an administrator take over operation of the property to complete the emergency problems with my housing. Direct the building owner to pay me a rent refund or credit for the month(s) of when my housing was not fixed. Direct the building owner to give me a rent reduction until the emergency problems are fixed. Directing the building owner to pay a fine if this Order is violated. Directing the building owner to pay reasonable attorney fees. To grant other relief deemed just and proper by the Court: American LegalNet, Inc. www.FormsWorkFlow.com HOU602 State ENG Rev 7/15www.mncourts.gov/formsPage 4 of 4Verification and Acknowledgements a.I have read this document. To the best of my knowledge, information, and belief theinformation contained in this document is well grounded in fact and is warranted by existing law. b.I have not been determined by any court in Minnesota or in any other State to be afrivolous litigant and I am not the subject of an Order precluding me from serving or filing this document. c.I am not serving or filing this document for any improper purpose, such as to harassthe other party or to cause delay or needless increase in the cost of litigation or to commit a fraud on the court. d.I understand that if I am not telling the truth or if I am misleading the court or if I amserving or filing this document for an improper purpose, the court can order me to pay money to the other party, including the reasonable expenses incurred by the other party because of the serving or filing of this document, court costs, and reasonable attorney fees. I declare under penalty of perjury that everything 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 signedAttorney Signature Block Dated: Signature County and State where signed Name: Address: City/State/Zip: Telephone: E-mail address: Attorney Lic. #: American LegalNet, Inc. www.FormsWorkFlow.com