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STATE OF MINNESOTA ) ) ss.

COUNTY OF

)

Affidavit of Mailing

, being duly sworn/affirmed on oath, state that on , I served the Notice of Motion, Motion and Affidavit for Order Directing Issuance

(Date)

of Title to a Motor Vehicle on by placing a true and correct copy thereof in an envelope addressed to him/her at their last known address (Defendant’s name)

at: ( address, city, state)

and depositing the same, with postage prepaid, in the United

States Mail at

,

Minnesota

.

Affidavit of Mailing

, being duly sworn/affirmed on oath, state that on , I served the Notice of Motion, Motion and Affidavit for Order Directing Issuance

(Date)

of Title to a Motor Vehicle on Commissioner of Public Safety

by placing a true and correct copy

thereof in an envelope addressed to: The Commissioner of Public Safety, C/O Attorney Generals Office, Public Safety Division, 445 Minnesota Street, Suite 1800, St. Paul, MN 55101-2134 and depositing the

same, with postage prepaid, in the United States Mail at

, Minnesota.

Dated:

Signature (Sign only in front of notary public or court administrator.)

Sworn/affirmed before me this

day of

,

.

Name: Address: City/State/Zip: Telephone:

Notary Public \ Deputy Court Administrator

MOV102

State

ENG

Rev 5/04

www.courts.state.mn.us/forms

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