STATE OF MINNESOTA)
)	ss
COUNTY OF HENNEPIN)

AFFIDAVIT OF SERVICE BY U.S. MAIL

Enter your name, being first duly sworn, hereby deposes and says that on the Type the figure date day of Type the month, 201__, at the City of Minneapolis, county and state aforementioned, she served the attached Enter the Order Name; Enter the docket number by depositing in the United States mail at said City of Minneapolis, a true and correct copy thereof, properly enveloped, with first class postage prepaid and addressed to the individuals named herein.

Enter party's name and address

Enter party's name and address

Enter your name

Subscribed and sworn to before me

this

Enter figure date

day of

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201___.

Notary Public