Affidavit of Non Compliance-Housing Court Pre-filing Mediation Last Revised 2/9/02 STATE OF MINNESOTA FOURTH JUDICIAL DISTRICT COUNTY OF HENNEPIN DISTRICT COURT AFFIDAVIT OF NON-COMPLIANCE ___________________________________________ Plaintiff HOUSING COURT PREFILING MEDIATION vs Case No. __________________________ ___________________________________________ Defendant I, __________________________, swear or affirm that on _____________, __________________________ print your name date agreement signed print other party’s name and I signed a Mediated Settlement Agreement (copy must be attached). _________________________________________ has not complied with the agreement by failing to print other party’s name do the following: Date: _____________________ ________________________________________________ Signature Subscribed and sworn to before me on ________________, 20___. _________________________________ Court Clerk/Notary If the agreement is not kept, fill out this document and return with a copy of agreement, complaint or affidavit of rent escrow and the appropriate filing fee to: Hennepin County Housing Court A-1700 Government Center 300 South 6th Street Minneapolis, MN 55487