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JGM103 State ENG Rev 12/17 www.mncourts.gov /forms Page 1 of 2 State of Minnesota District Court County Judicial District: Court File Number: Case Type: Civil Affidavit of Identification of Judgment Creditor (Minn. Stat. § 548. 28, subd. 1) Plaintiff vs Defendant ___________________________________________ says that he/she is the Judgment Creditor, or the _________________________ for the Judgment Creditor, that to the best of his/her knowledge, information, and belief, the full name(s) of the Judgment Creditor(s) in the a ction 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: JGM103 State ENG Rev 12/17 www.mncourts.gov /forms Page 2 of 2 That the post office address(es) of said judgment creditor(s) is as follows: I declare under penalty of perjur y that everything I have stated in this document is true and correct. Minn. Stat. § 358.116. Dated: County and State where signed Signature Name: Address: City/State/Zip: Telephone: E-mail address: