FORM 104 CERTIFICATE OF REPRESENTATION AND PARTIES
FORM 104 CERTIFICATE OF REPRESENTATION AND PARTIES
STATE OF MINNESOTA DISTRICT COURT
COUNTY OF ________ ________ JUDICIAL DISTRICT
CASE NO. _________________
CERTIFICATE OF REPRESENTATION AND PARTIES
**(ONLY THE INITIAL FILING LAWYER/PARTY NEEDS TO
COMPLETE THIS FORM)**
Date Case Filed: ____________________
____________________________________ vs. ________________________________
This certificate must be filed pursuant to Rule 104 of the General Rules of Practice for the District Courts, which states: “A party filing a civil case shall, at the time of filing, notify the court administrator in writing of the name, address, and telephone number of all counsel and unrepresented parties, if known (see form 104 appended to these rules). If that information is not then known to the filing party, it shall be provided to the court administrator in writing by the filing party within seven days of learning it. Any party impleading additional parties shall provide the same information to the court administrator. The court administrator shall, upon receipt of the completed certificate, notify all parties or their lawyers, if represented by counsel, of the date of filing the action and the file number assigned.”
LIST ALL LAWYERS/PRO SE PARTIES INVOLVED IN THIS CASE.
LAWYER FOR PLAINTIFF(S) LAWYER FOR DEFENDANT(S)
(if not known, name party and address)
________________________________ _____________________________________
Name of Party Name of Party
________________________________ _____________________________________
Atty Name (Not firm name) Atty Name (Not firm name)
_________________________________ ____________________________________
Address Address
_________________________________ ____________________________________
_________________________________ ____________________________________
_________________________________ ____________________________________
Phone Number Phone Number
_________________________________ ____________________________________
MN Atty ID No. MN Atty ID No.
(Please use other side for additional lawyers/parties).
_________________________________ ____________________________________
Date Filing Lawyer/Party
Lawyer for: Lawyer for:
__________________________________ _____________________________________
Name of Party Name of Party
__________________________________ ____________________________________
Atty Name (Not firm name) Atty Name (Not firm name)
__________________________________ _____________________________________
Address Address
__________________________________ _____________________________________
__________________________________ _____________________________________
__________________________________ _____________________________________
Phone Number Phone Number
__________________________________ _____________________________________
MN Atty ID No. MN Atty ID No.
Lawyer for: Lawyer for:
__________________________________ _____________________________________
Name of Party Name of Party
__________________________________ _____________________________________
Atty Name (Not firm name) Atty Name (Not firm name)
__________________________________ _____________________________________
Address Address
_________________________________ _____________________________________
_________________________________ _____________________________________
_________________________________ _____________________________________
Phone Number Phone Number
_________________________________ ____________________________________
MN Atty ID No. MN Atty ID No.
................
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