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Office of the Revisor of Statutes

APPELLATE PROCEDURE

FORM 115A - PETITION FOR WRIT OF CERTIORARI

STATE OF MINNESOTA

IN COURT OF APPEALS

CASE TITLE:
PETITION FOR WRIT
OF CERTIORARI
Petitioner,
vs.COURT OF APPEALS NUMBER:
(AGENCY OR BODY)
Respondent,NUMBER:
(Agency or Body),DATE OF DECISION:
Respondent.
DATE AND DESCRIPTION OF EVENT TRIGGERING APPEAL TIME (for
example, mailing of decision, receipt of
decision, or receipt of other notice);
TO:The Court of Appeals of the State of Minnesota:

The above-named petitioner hereby petitions the Court of Appeals for a Writ of Certiorari to review a decision of the (agency or body) issued on the date noted above, upon the grounds that (specify grounds and statute authorizing certiorari review).

DATED:
NAME, ADDRESS, ZIP CODE, TELEPHONE NUMBER, AND ATTORNEY REGISTRATION LICENSE NUMBER OF ATTORNEY(S) FOR PETITIONER:
_
SIGNATURE OF ATTORNEY
OR, IF NOT REPRESENTED BY COUNSEL:
NAME, ADDRESS, ZIP CODE, AND TELEPHONE NUMBER OF PETITIONER:
_
SIGNATURE OF PETITIONER

(The procedure for obtaining a writ of certiorari from the Court of Appeals is set forth in the applicable statutes and in Rule 115, Rules of Civil Appellate Procedure. The applicable statutes prescribe the subject matter of writs in the Court of Appeals, time limitations, and requirements for service. The rule prescribes the manner of securing a writ, contents of the petition, bonds, filing and fees, and preparation of the record. An original and one copy of a completed statement of the case must accompany the petition.

The date of the event that triggered the appeal period must be indicated on the petition. The nature of this event varies, depending on the requirements of the statute authorizing certiorari review in the Court of Appeals. See MINN.R.CIV.APP.P. 115 comment.)

(Amended effective for appeals taken on or after January 1, 1992; amended effective January 1, 1999.)