State of Minnesota District Court: County Judicial District: Court File Number: Case Type
State of Minnesota District Court: County Judicial District: Court File Number: Case Type
,
Plaintiff/Petitioner
Notice and Application for
And Taxation of Costs and Disbursements
.
Defendant/Respondent
To:
Name of other party
and
County Court Administration
(Name of County)
State of Minnesota )
) SS
County of )
I declare under penalty of perjury that everything I have stated in this document is true and
correct. Minn. Stat. § 358.116.
Signature
Address
E-mail address
TOTAL ALLOWED: $
This above bill of Costs and Disbursements taxed and allowed as indicated in the right-hand column,
above.
By
District Court Administrator Deputy Administrator
Attorney or Adverse Party’s name if no attorney Attorney or Adverse Party’s name if no attorney
For For
(Name of Party) (Name of Party)
Attorney or Adverse Party’s name if no attorney Attorney or Adverse Party’s name if no attorney
For For
(Name of Party) (Name of Party)
Note: If adverse party is not represented by an attorney, cross out Attorney and print adverse party’s name (use
additional pages to identify additional parties)
State of Minnesota )
)
County of )
I, , of the City of ,
County of , State of Minnesota, that on the day of
, , served the Notice and Application for Taxation of Costs
and Disbursements incurred by prevailing party on the person(s) named below by mailing a copy
thereof, enclosed in an envelope, postage prepaid, and by depositing the same in the post office
at , directed to the attorney / party at the
following address(es):
Name Name
Address Address
I declare under penalty of perjury that everything I have stated in this document is true and
correct. Minn. Stat. § 358.116.
Signature of Affiant