Fill and Sign the Minnesota Confession Form

STATE OF MINNESOTA DISTRICT COURT COUNTY OF             JUDICIAL DISTRICT FAMILY COURT DIVISION In Re the Marriage of: Court File No.             , Petitioner, PROMISSORY NOTE AND CONFESSION AND OF JUDGMENT       , Respondent, I, Name , hereby admit, acknowledge, and confess that there is actually and justly due from me to Name of Law Firm , as of Date , the sum of $ __________ , and that the facts out of which said indebtedness arose are as follows: On or about _________ , I retained the Firm for legal representation in my divorce. During the Firm's representation of me, I received monthly billing statements, which I was obligated to pay pursuant to the retainer agreement. I was unable to stay current on said obligation, and entered into a payment plan with the Firm, according to which I would pay the bill in monthly installments of $ to $ . I have been unable to pay the monthly amount consistently. As of Date , the full balance is $ ____________ . Further, I promise to pay said balance by monthly installment payments of $ , to be paid by the fifteenth day of each month, commencing immediately. I make this promise in consideration of my obligation stated above to pay attorney's fees due and owing, and the Firm's agreement to forego any legal action to collect said fees until such time as I have defaulted on my payments pursuant to the terms herein. The sum above stated does not exceed my debt and liability to the Firm. I hereby authorize and empower the court above-named, if the Firm so requests upon my default on the above-stated promise, to enter judgment against me in favor of the Firm, for any unpaid portion of the sum above specified. Dated: __________ Petitioner/Respondent Subscribed and sworn to before me this _____ day of ____________, 20___. _______________________________ NOTARY PUBLIC - 2 -