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Admission of Service of Summons and Petition for Dissolution of Marriage

The Plaintiff serves this form to the Defendant of a divorce case. Defendant must accomplish this form and return the completed version to the Petitioner. Upon receipt, Petitioner must file the form with the clerk’s office. Successful filing of this form notifies the court that Defendant has received copies of all the divorce papers.

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State of Minnesota 	 	 	District Court	
County 	 	Judicial District: 	 	
 	 	Court File Number: 	 	
 	 	Case Type: 	Dissolution with Children	
 
In the Matter of:  
 
      	 	
Petitioner 
 
and 	Admission of Service of Summons and	 	
 	Petition for Dissolution of Marriage	 	
      	 	
Respondent 
 
 
I, the undersigned Respondent, acknowledge that I have personally r eceived a copy of the 
Summons and Petition for Dissolution  of Marriage.  I understand that: 
 
1. Signing this document starts th e divorce/dissolution process; 
 
2. Signing this document does not mean that I  agree with everything in the Petition for 
Dissolution of Marriage.  It on ly means that I have received a copy of the Summons and 
Petition; 
 
3.  I have thirty (30) days from the date of  signing this document to serve on the Petitioner 
an Answer to the Petition; 
 
4.  If I do not serve an Answer within thirty (30) days, I will be found in default and 
Petitioner may ask the Court to give him/her everything (s)he has asked for in the Petition 
for Dissolution of Marriage; 
 
5. I do not have to sign this Admission.  But if  I do not sign, Petitioner can commence the 
divorce/dissolution by having  the Summons and Petition for Dissolution of Marriage 
personally served upon me and I may have to  pay the cost of Petitioner doing this. 
 
I declare, under penalty of perjury, that I personally received a copy of the Summons and Petition  
at     	
,    	on       	. 	
             (City)            (State)                        (Month/Day/Year you received the papers). 
 
Dated:      	        	 	
      	Signature  (Sign only in front of notary  public or court administrator.) 	
  Name:       	 	
Sworn/affirmed before me this  Address:       	  	
 	 day of 	  , 	. 	City/State/Zip:      	 	
       	 	Telephone:  	( ) 	
Notary Public  Deputy Court Administrator   
DIV805 State  ENG  Rev 11/01-D   www.courts.state.mn.us/forms  Page 1 of 2

State of Minnesota 	 	 	District Court	
County 	 	Judicial District: 	 	
 	 	Court File Number: 	 	
 	 	Case Type: 	Dissolution with Children	
 
In the Matter of:  
 
      	 	
Petitioner 
 
and 	Affidavit of Personal Service	 	
  
      	 	
Respondent 
 
 
STATE OF MINNESOTA      ) 
      )  SS 
COUNTY OF      	) 	
     (County where Affidavit signed) 
 
I,       	, being sworn, state that I am  at least 18 years of age  	
    (Name of person who hand-delivered documents) 
having been born on          	, and that on        	, 	
I served the Summons and Petition fo r Dissolution of Marriage upon        	  	
           (Name of other party) 
     	 by handing a true and correct copy of the documents to 	
him/her at:            	 	
            street address                    city                          state 
 
 
 
      Signature of Person who Served the Documents 
 
Dated:      	        	 	
      	Signature (Sign only in front of notary  public or court administrator.) 	
  Name:       	 	
Sworn/affirmed before me this  Address:       	  	
 	 day of 	  , 	. 	City/State/Zip:      	 	
       	 	Telephone:  	( ) 	
Notary Public  Deputy Court Administrator   
DIV805 State  ENG  Rev 11/01-D   www.courts.state.mn.us/forms  Page 2 of 2
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