Preview
46-CV-22-694
Filed in District Court
State of Minnesota
8/4/2022 11:34 AM
State of Minnesota District Court
of: Judicial District:
Court File Number:
lt( ar,l h,^ Case Type: Housing
Affidavit of Rent Escrow
(Minn. Stat. $ 5048.385)
Defendant (La
My name i" h;*Ar/- t te -Q ,fu-, , I understand that I
must tell the truth when answering the following questions:
l. I am a tenant with the right tp live at the located the following
at address:
Address: /, \,^- .tr t
Street Address Apt. or Unit Number
CitylSt.lZip:
County:
Phone:
2. The name, address, and phone number forJhe owners(s) of the property are:
Name:
Address: uJ- 5aosl
Street Address Apt. No. Cityls
Phone:
3. The name, address, and phone number for the managers(s) of the property (if different
from the owner) are:
Name:
Address:
Phone: 6ot. t=a ' Cz> |
Affidavit for Rent Escrow
HOU302 State ENG Rev 1121 www. mncourts. govfforms Page 1 of 4
46-CV-22-694
Filed in District Court
State of Minnesota
8/4/2022 11:34 AM
4. The following is a list of all problem(s) or violation(s) regarding my apartment or rental
housing:
ffi
Cn"ra_g
5. I estimate the cost repair problems tob" fuf yo., have no idea of
5kn3_
the estimated cost, you should contact someone to give you a professional estimate.)
6. The landlord or manager received the following written notice about the problems or
violations with my apartment or rental housing: (Check all that apply)
I a. On the following date, , the City Inspector issued an order, a copy
of which is attached, ordering the landlord or manager to fix the problem or
violations by AND:
S t. ffre landlord and manager did not complete the repairs on time OR
'fZ. The City Inspector gave the landlord or manager too much time to complete
the repairs, because:
ffiu.onthefol1owingdu,",Wmailedorhanddeliveredtothe
B hndlord ffi manager a written list of repairs needed or other problems with
my apartment or'rental housing. It has been at least 14 days since I provided the
landlord and/or manager with the written notice and the landlord and/or manager have
not completed the repairs or fixed the problems. I have attached a copy of the list of
repairs.
7. Myrent r" 575 permonthdueonthe |* ofeachmonth.
As of this date: (check one)
O a. My rent is paid in full and no rent is due until: . If this case
is not resolved by that date, then on or before that date I will deposit with the court
the amount of rent due.
%
Bb. Rent in the amount of b15 is now due and I am depositing this
amount with the court.
Affidavit for Rent Escrow
HOU302 State ENG Rev 1/21 www. mncourts. gov/forms Page 2 of 4
46-CV-22-694
Filed in District Court
State of Minnesota
8/4/2022 11:34 AM
8. I ask the court to order one or more of the following (check all that apply):
rffit a. problems
Directing the landlord and/or manager to complete the repairs and/or fix the
with my housing.
! U. Allowing me to complete the repairs and/or fix the problems with my housing and
deduct the costs from my rent.
M
/\
.. Directing that an administrator take over operation of the property to complete the
repairs and/or fix the problems with my housing.
[f a. Directing the landlord and/or manager to pay me a rent refund for the month(s)
when my housing was not fixed.
! e. Directing the landlord and/or manager to give me a rent reduction each month until
the repairs are completed and problems fixed.
ffi f. Oirecting the landlord and/or manager to pay a fine if this Order is violated.
p e. Directing the landlord and/or manager to pay reasonable attorney fees.
M other:
all_!
and ordering other relief deemed just and proper by the court.
4sL
Verification and Acknowledgment
By presenting this form to the court, I certifu that to the best of my knowledge, information, and
belief, the following statements are true. I understand that if a statement is not true, the court can
order a penalty against me (such as to pay money to the other party, pay court costs, and/or other
penalties).
1. The information I included in this form is based on facts and supported by existing law.
2. I amnot presenting this form for any improper purpose. I am not using this form to:
a. Harass anyone;
b. Cause unnecessary delay in the case; or
c. Needlessly increase the cost of litigation.
3. No judicial officer has said I am a frivolous litigant.
4. There is no court order saying I cannot serve or file this form.
5. This form does not contain any "restricted identifiers" or confidential information as
defined in Rule 11 of the General Rules of Practice (https://www.revisor.mn.gov/
court:rules/gp/id/l l/) or the Rules of Public Access to Records of the Judicial Branch
(https ://www.revisor.mn. gov/court:rules/rule/ra-toh,l).
Affidavit for Rent Escrow
HOU302 State ENG Rev 1121 www. m ncou rts. gov/forms Page 3 of 4
46-CV-22-694
Filed in District Court
State of Minnesota
8/4/2022 11:34 AM
6. If I need to file "restricted identifiers," confidential information, or a confidential
document, I will use Form I l.l and/or Form 11.2, as required by Rule I 1.
I declare under penalty of perjury that everything that I have stated in this document is true and
correct. Minn. Stat. $ 358.116.
Dated: 9,3.;)o)^
ounty and State
CitylState/Zip: 40 3l
Telephone: b1- 236 -
E-mail address: y-o,rLLs.n! .2fi @
?t
tr/- Cur-.,
Affidavit for Rent Escrow
HOU302 State ENG Rev 1/21 www. m ncou rts. govlforms Page 4 of 4
46-CV-22-694
Filed in District Court
State of Minnesota
8/4/2022 11:34 AM
l\r-eq
r-/ /
/i, Pa';A
,)l,u t t ru W+ rf, ft-t'r/xl't'{ tt
!
+hef 4utov' +o fu rry1,-L\-
ut y{i"/ Ddd4a
l'-lC"rrc,^* tVr.r,n
=a on'l*'l' ,^ ltu'nu
-: I.+ caCp,r/
o3 ; [] n'l /',.tcio{xt ,
,1
-. )ru42t^'1 ' , .2
'*o:dxt' .$ '7tQ,[/-
Preview
46-CV-22-694 Filed in District Court State of Minnesota 8/4/2022 11:34 AM State of Minnesota District Court of: Judicial District: Court File Number: lt( ar,l h,^ Case Type: Housing Affidavit of Rent Escrow (Minn. Stat. $ 5048.385) Defendant (La My name i" h;*Ar/- t te -Q ,fu-, , I understand that I must tell the truth when answering the following questions: l. I am a tenant with the right tp live at the located the following at address: Address: /, \,^- .tr t Street Address Apt. or Unit Number CitylSt.lZip: County: Phone: 2. The name, address, and phone number forJhe owners(s) of the property are: Name: Address: uJ- 5aosl Street Address Apt. No. Cityls Phone: 3. The name, address, and phone number for the managers(s) of the property (if different from the owner) are: Name: Address: Phone: 6ot. t=a ' Cz> | Affidavit for Rent Escrow HOU302 State ENG Rev 1121 www. mncourts. govfforms Page 1 of 4 46-CV-22-694 Filed in District Court State of Minnesota 8/4/2022 11:34 AM 4. The following is a list of all problem(s) or violation(s) regarding my apartment or rental housing: ffi Cn"ra_g 5. I estimate the cost repair problems tob" fuf yo., have no idea of 5kn3_ the estimated cost, you should contact someone to give you a professional estimate.) 6. The landlord or manager received the following written notice about the problems or violations with my apartment or rental housing: (Check all that apply) I a. On the following date, , the City Inspector issued an order, a copy of which is attached, ordering the landlord or manager to fix the problem or violations by AND: S t. ffre landlord and manager did not complete the repairs on time OR 'fZ. The City Inspector gave the landlord or manager too much time to complete the repairs, because: ffiu.onthefol1owingdu,",Wmailedorhanddeliveredtothe B hndlord ffi manager a written list of repairs needed or other problems with my apartment or'rental housing. It has been at least 14 days since I provided the landlord and/or manager with the written notice and the landlord and/or manager have not completed the repairs or fixed the problems. I have attached a copy of the list of repairs. 7. Myrent r" 575 permonthdueonthe |* ofeachmonth. As of this date: (check one) O a. My rent is paid in full and no rent is due until: . If this case is not resolved by that date, then on or before that date I will deposit with the court the amount of rent due. % Bb. Rent in the amount of b15 is now due and I am depositing this amount with the court. Affidavit for Rent Escrow HOU302 State ENG Rev 1/21 www. mncourts. gov/forms Page 2 of 4 46-CV-22-694 Filed in District Court State of Minnesota 8/4/2022 11:34 AM 8. I ask the court to order one or more of the following (check all that apply): rffit a. problems Directing the landlord and/or manager to complete the repairs and/or fix the with my housing. ! U. Allowing me to complete the repairs and/or fix the problems with my housing and deduct the costs from my rent. M /\ .. Directing that an administrator take over operation of the property to complete the repairs and/or fix the problems with my housing. [f a. Directing the landlord and/or manager to pay me a rent refund for the month(s) when my housing was not fixed. ! e. Directing the landlord and/or manager to give me a rent reduction each month until the repairs are completed and problems fixed. ffi f. Oirecting the landlord and/or manager to pay a fine if this Order is violated. p e. Directing the landlord and/or manager to pay reasonable attorney fees. M other: all_! and ordering other relief deemed just and proper by the court. 4sL Verification and Acknowledgment By presenting this form to the court, I certifu that to the best of my knowledge, information, and belief, the following statements are true. I understand that if a statement is not true, the court can order a penalty against me (such as to pay money to the other party, pay court costs, and/or other penalties). 1. The information I included in this form is based on facts and supported by existing law. 2. I amnot presenting this form for any improper purpose. I am not using this form to: a. Harass anyone; b. Cause unnecessary delay in the case; or c. Needlessly increase the cost of litigation. 3. No judicial officer has said I am a frivolous litigant. 4. There is no court order saying I cannot serve or file this form. 5. This form does not contain any "restricted identifiers" or confidential information as defined in Rule 11 of the General Rules of Practice (https://www.revisor.mn.gov/ court:rules/gp/id/l l/) or the Rules of Public Access to Records of the Judicial Branch (https ://www.revisor.mn. gov/court:rules/rule/ra-toh,l). Affidavit for Rent Escrow HOU302 State ENG Rev 1121 www. m ncou rts. gov/forms Page 3 of 4 46-CV-22-694 Filed in District Court State of Minnesota 8/4/2022 11:34 AM 6. If I need to file "restricted identifiers," confidential information, or a confidential document, I will use Form I l.l and/or Form 11.2, as required by Rule I 1. I declare under penalty of perjury that everything that I have stated in this document is true and correct. Minn. Stat. $ 358.116. Dated: 9,3.;)o)^ ounty and State CitylState/Zip: 40 3l Telephone: b1- 236 - E-mail address: y-o,rLLs.n! .2fi @ ?t tr/- Cur-., Affidavit for Rent Escrow HOU302 State ENG Rev 1/21 www. m ncou rts. govlforms Page 4 of 4 46-CV-22-694 Filed in District Court State of Minnesota 8/4/2022 11:34 AM l\r-eq r-/ / /i, Pa';A ,)l,u t t ru W+ rf, ft-t'r/xl't'{ tt ! +hef 4utov' +o fu rry1,-L\- ut y{i"/ Ddd4a l'-lC"rrc,^* tVr.r,n =a on'l*'l' ,^ ltu'nu -: I.+ caCp,r/ o3 ; [] n'l /',.tcio{xt , ,1 -. )ru42t^'1 ' , .2 '*o:dxt' .$ '7tQ,[/-