MINNESOTA COURT RULES

GENERAL RULES OF PRACTICE

PART G. APPENDIX OF FORMS

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

FORM 104 CERTIFICATE OF REPRESENTATION AND PARTIES

State of Minnesota
		District Court
	_
	JUDICIAL DISTRICT	CASE NO.
COUNTY
_	_
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.