JGM103 State ENG Rev 12/17www.mncourts.gov/formsPage 1 of 2State of Minnesota District Court County of: Select County Judicial District: Court File Number: Case Type: Civil Plaintiff (first, middle, last)vs. Defendant (first, middle, last)Affidavit of Identification of Judgment Creditor (Minn. Stat. 247 548.28, subd. 1) says that he/she is the Judgment Creditor, or the for the Judgment Creditor, that to the best of his/herknowledge, information, and belief, the full name(s) of the Judgment Creditor(s) in the action above entitled is as follows: That the business and occupation of said judgment creditor(s) is as follows: That the place(s) of residence of said judgment creditor(s) is as follows: That the place(s) of business of said judgment creditor(s) is as follows: That the post office address(es) of said judgment creditor(s) is as follows: American LegalNet, Inc. www.FormsWorkFlow.com JGM103 State ENG Rev 12/17www.mncourts.gov/formsPage 2 of 2I 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/ County and State where signed Name: Address: City/State/Zip: Telephone: E-mail address: American LegalNet, Inc. www.FormsWorkFlow.com