State of Minnesota County Judicial District: Court File Number: Case Type: District Court Name Change In the Matter of the Application of: First Middle Last On Behalf of (current name of minor(s)): Affidavit of Personal Service First Middle Last For a change of name to (new name of minor(s)): First Middle Last STATE OF MINNESOTA COUNTY OF (County where Affidavit signed) ) ) SS ) , state that I am at least I, (Name of person who hand-delivered documents) 18 years of age having been born on and that on , I served the Application for a Name Change of a Minor and a notice of hearing upon (Full name of non-applicant parent) at served) by handing a true and correct copy of the documents to him/her. (address where documents were 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: ) NAM205 State ENG Rev 7/15 www.mncourts.gov/forms Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com