Affidavit of Service by Mail

State of Minnesota                   )

County of ___________________)
(county where filing cost-of-living adjustment)
 
 

___________________ of the City of ______________ County of __________________
(your name)

in the State of _________, being duly sworn says that on the ______ day of ______ 20___

he/she served the Cost of Living Adjustment Form and Letter of Notification on

__________________________ by mailing to him/her a copy of it, enclosed in an
(name of child support/spousal maintenance payor)

envelope, postage prepaid, and by depositing it in the post office at

___________________________ directed to him/her at the last known address, at
(city where mailed)

 

___________________________

___________________________

___________________________
(address of child support/spousal maintenance payor)

__________________________________

(sign your name here in front of the Notary Public)

Subscribed and sworn before me

this ________ day of _________, 20___.
                                     (month)

___________________________
Notary Public