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STATE OF MINNESOTA DISTRICT COURT COUNTY OF__________________________ JUDICIAL DISTRICT FAMILY COURT DIVISION In Re the Marriage of: Court File No. __________________________, Petitioner, CERTIFICATE OF DISSOLUTION AND_____________, Respondent, YOU W IL L P L EA SE T A KE N OTIC E T H AT:1. a. The t r u e a n d c o rre ct n am e o f t h e P etitio ner i s : _ ________________ b. The p rio r o r o th er n am es o f t h e P etitio ner a re : _ ________________ 2. a. The t r u e a n d c o rre ct n am e o f t h e R esp onden t i s : _ ________________ b. The p rio r o r o th er n am es o f t h e R esp onden t a re : _ ________________ 3. There a re n o l iv in g m in or o r d ep en den t c h ild re n o f t h e p artie s' m arria g e. O R 3. The n am es o f th e p artie s' m in or o r d ep en den t c h ild re n a s id en tif ie d in th e J u dgm en t an d D ecre e a re : - 2 - __________ ________ ______________ __;_ _________ ________ ______________ __; a n d__________ ________ ______________ __. 4 . The m arria g e o f th e p artie s w as d is so lv ed b y Ju dgm en t a n d D ecre e o f th e C ourt en te re d o n t h e _ __________ d ay o f _ __________, 2 0_ _.5 . This C ertif ic ate o f D is so lu tio n sh all b e co nclu siv e ev id en ce o f th e fa cts re cite d here in p urs u an t t o M in n. S ta t. § 518.1 48. D ate d : _ ______ __________ __ REC O M MEN DED B Y : __________________________R efe re e o f D is tr ic t C ourt D ate d : _ ______ __________ __ BY T H E C O URT: ___________________________Ju dge o f D is tr ic t C ourt