Minnesota to County Support and Corrections Form

In a divorce case in the State of Minnesota, the Notice to County Support and Collections form has to be completed and submitted for notifying a spouse that a divorce case has been filed against them so they can take the proper legal action.

Extracted Text for Proper Search

Court File Number:   
 
In the Matter of: 
 
_________________________________  
_________________________________ 
_________________________________ 
Petitioner’s Name and Address 
Vs.             	Notice to 	
             	County Support and Collections 	
_________________________________ 
_________________________________    Minn. Stat. §518.551, subd. 5 
_________________________________ 
Respondent’s Name and Address 
 
To:	_____________________________________       PRISM No. (if known)   	    
(Write your Support and Collections worker’s name) 
       	
 Petitioner    	 Respondent    is a recipient of  or is applying for ( check all that 
apply):  
 	
 MFIP  	 Medical Assistance  	 IV-E Foster Care   	 Tribal TANF 
                 	
 Child Care Assistance     	 MinnesotaCare      
2.  Petitioner’s birth da te is:        	
. 
3.  Respondent’s birth date is:        .
    
4.  Petitioner’s and Respondent’s social  security numbers are on the attached 
document:“Form 11: Confidential Information.”     (Note: Attach Form 11 only to copy 
delivered to Support and Collections. Do not  attach Form 11 to copy filed in the Court 
file.) 	
                       
      	
     	 
       Signature of Petitioner               
 
      Telephone Number 	
 
DIV813 State  ENG  Rev 2/03-D    www.courts.state.mn.us/forms Page 1 of 2

Court File Number:   
 
In the Matter of: 
      	
 
Petitioner       Affidavit of Mailing or Delivery of  
vs.         Notice to County Support andCollections 
      
 
Respondent 
 
STATE OF MINNESOTA      ) 
COUNTY OF       
) SS 
        (County where Affidavit signed) 
 I,         	
, being sworn, state that on 
(month, day, year)         	
,   	, I (check one)	 hand-
delivered OR  	
mailed     the Notice of my court action to Support and Collections by 
(check one)	
 delivering a copy to the receptionist  of the Support and Collections office 
located at:                             	
OR 
 	
 by placing in an envelope a true an d correct copy addressed to       	
   	 at         	  in the City of   	
       	 State of                	Zip Code ____________ and depositing 
the envelope, with sufficient postage, in the Un ited States Mail at the Post Office located 
in the City of        	
 in the State of              	. 
            
 
     	
Signature of Person Who Mailed or delivered Documents 	
         	(Sign  only	 in presence of Notary Public) 
          Note:  Petitioner may mail or deliver the Notice to Support 
       and Collections him/herself 	
Date:        	 
  Month       Day     Year 
 
 
  Address: 
       	
City & State:             	
Telephone:                     	
                (of person who mailed documents) 
Sworn/affirmed to before me this 
 	
 Day of      	,   	. 
       
 
Notary Public/Deputy Court Administrator 
 	
DIV813 State  ENG  Rev 2/03-D    www.courts.state.mn.us/forms Page 2 of 2