Fillable Printable Certificate of Service Form - Minnesota

Certificate of Service Form - Minnesota

FORM 115C. CERTIFICATE OF SERVICE AND FILING

OF ITEMIZED LIST

STATE OF MINNESOTA

IN COURT OF APPEALS

CASE TITLE:

Relator, CERTIFICATE OF SERVICE AND

FILING OF ITEMIZED LIST

vs.

Court of Appeals

Respondent,

APPELLATE COURT CASE NUMBER:

(Agency or Body),

Respondent. (AGENCY OR BODY) NUMBER:

TO: Clerk of the Appellate Courts

Minnesota Judicial Center

St. Paul, MN 55155

A copy of the itemized list of the contents of the record is attached to this certificate, was

served on each separately-represented party to this proceeding, and is transmitted to the clerk of

appellate courts in accordance with Rules 115.04, subdivision 3, and 111.01. Service was made

as follows:

Party Name Address Date Served Method of Service

Clerk of Appellate Courts Minnesota Judicial Center

St. Paul, MN 55155

etc.

DATED:

___________________________

SIGNATURE

ADDRESS AND TELEPHONE NUMBER

cc: All Counsel of Record

(Rule 115.04, subd. 3, requires the service and filing of the itemized list of the contents of the

record as specified in Rule 111.01 to take place within 30 days after service of the petition for

writ of certiorari or 14 days after delivery of a transcript, whichever is later. This notice requires

service and filing of the itemized list of the record; the actual record is to be retained until the

clerk of appellate courts requests that it be transmitted to the court. See Rule 115.04, subd. 5.)