Party Statement: Everett Henry vs Wholesale Auto Repair Shop

• 
• 
• 
• 

						
                                
Preview
                                '2'

                                                                          2"
                                                                               K)
                                                                                A")
                                               r-
                                                    L
                                                    f




                                                                          "
                   See instructions (CCT100) for help in filling out this form.
State of Minnesota                                                                             Conciliation Court

County of:
             HWMEfM/W
                                                                    Court File Number: 7/7    "[0   'Z%-— 4%?33
Judicial District: Ll                                               Case Type: Conciliation   11 '0)! 'IL3'         Bl W
    (wart         HeNaxA'

Plaintiff

vs
    wHCLESALe.        mm) mpfli'iz suop

Defendant

Cl Check the box if there are more than two plaintiffs or more than two defendants. List the
    names and information for the other parties on the Additional Litigants Form (CCT702).


                           Conciliation Court Affidavit of Service (CCT103)

My name is [YEMLQALE               HMHLJ
|   am at least 18 years old.       l   served documents regarding this Conciliation Court case as follows:


                                        Documents Served on Other Party

|   served the following document(s): Check all that apply.
          D Summons: Conciliation Court (NOTE: the Summons must be served on Defendant by
              Certified Mail or personal service)
          D Plaintiff's Statement of Claim (NOTE: the Statement of Claim must be served on
            Defendant by Certified Mail or personal service)
          D Motion to Vacate Judgment and Supporting Affidavit
              Demand for Removal/Limited Removal
          D   Other document (specify):

                                                    Details of Service

l   served the documents checked above on the following party:
          Name:

          ORfll served this party's attorney instead of the party.


Conciliation Court Afiidavit of Service
CCT103        State   Eng         Rev 8/23              www.mncourts.gov/forms                           Page   1   of 2
                 -)     Check the box showing the type of service used (certified, first-class, or personal
                        service), and fill in the date and location of service.

I       served the other party by:

                            [3 Certified Mail, postage prepaid                —l   mailed the documents on                  (date),
                               from                                                                                (city, state).

                                  Regular First-Class Mail
                                                                 —
                                                                     I   mailed the documents on                  q(date), from
                                     M (Y)         (.l 3                                                           (city, state).
                                            Wipe
                            El Personal Service (hand-delivered) —l hand—delivered the documents to the
                                  other party on:                        (date) at the following location:

                                      Address:

                                      City/State/Zip:

                            NOTE: The Summons and'Statement of Claim cannot be served on Defendant by
                            regular first—class mail.

                                       Service Not Completed (Party Not Found)

          [3 After a careful search, l was not able to find the following party (or any residence or
              business address for this party):

                 I   could not find    a   way to serve this party.


 declare under penalty of perjury that everything
    I                                                  stated                  I             In   this document    IS   true and
                                                  have
correct. Minn. Stat. § 358.116

    Date:
                     "(920('7/3
                                                        Signature.          (jug,                            \m
                                                        Name:        FVCKJQTIT      HP" KM
County and state where signed:                          Address:           5640      CHHUA Livy?"      £203
«Hr/nunm
             '
                         MM
                                                        phone: 311/ "vi'bl
                                                                                      ,
                                                        City/State/Zip: linvcr Fri/ova, lr'lciams
                                                                                 Na") d
                                                                                                             W)          "£7507Q

                                                        Email:                                bé                   .
                                                                                                                       COW"
                                                                            encrm.r\jl               Qflflxmfl




Conciliation Court Afiidavit of Service
CCT103        State   Eng         Rev 8/23                  www.mncourts.gov/forms                                            Page 2 of 2