STATE OF MINNESOTA

OFFICE OF ADMINISTRATIVE HEARINGS

ADMINISTRATIVE LAW SECTION

600 NORTH ROBERT STREET

ST. PAUL, MN 55164

CERTIFICATE OF PERSONAL SERVICE

Case Title:

OAH Docket Number:

___________________ certifies that on the ______ day of ________, ________, (s)he

            (Name)                                                (date)               (month)            (year)

served a true and correct copy of the attached subpoena by personally handing it to the

following individual:

            Name:

            Address:

                                                                        _________________________________

                                                                        (signature of person who served the subpoena)