Fill and Sign the Affidavit of Personal Service by Peace Officer or Corrections Form

OFP502 State ENG Rev 7/15 www.mncourts.gov/forms Page 1 of 1 State of Minnesota District Court County Judicial District: Court File Number: Case Type: Domestic Abuse In the Matter of: Petitioner Affidavit of Personal Service by Peace Officer/Corrections Officer vs. (Domestic Abuse) (Minn. Stat. § 518B.01, subd. 8) Respondent STATE OF MINNESOTA ) ) SS COUNTY OF ) (County where Affidavit sig ned) I, _______________________________ state that I am a: Peace officer licensed by the state of Minnesota, or Corrections officer, including but not limited to probatio n officer, court services officer, parole officer or a jail or correctional facility employee. On , I personally served true and correct copies of the foll owing: (Month, Day, Year Hand-delivered) (Place an X in the box next to the documents that you served.) Affidavit of (Name of person who signed Affidavit) Petition for Order for Protection Notice of Hearing Ex parte Order for Protection Other: (Title of any other documents served) upon , in the above-entitled matter at: (Name of Respondent) Street Address: (Include name of the facility if appropriate.) City & State: 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: