MINNESOTA COURT RULES

APPELLATE PROCEDURE

Forms provided here are for reference purposes. To download forms to fill out please visit the Minnesota Courts website.

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	Minnesota Judicial
Courts	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.)

(Added effective January 1, 2010.)