TO:      , the opposing party:

            PLEASE TAKE NOTICE that the undersigned requests a review of the recommended Order and Findings of the Housing Court Referee in this case by a District Court Judge at a time and place set aside for the hearing of such a review by the Court.

            1.         This request for review is made upon the following grounds: .

            2.         The specific provision(s) of the recommended findings or orders disputed is/are: .

            3.         A stay of execution of judgment:

                        a.         □          is requested. The undersigned proposes payment into court in lieu of bond in the amount of her monthly rent for of $_____, on or before 4:00 p.m. on ___________________________, and $_____ by the ___ day of each month while judge review is pending.

                        b.         □          is not requested.

            4.         Transcript of proceedings.

                        a.         □          The undersigned requests a transcript of proceedings.

                                    i.         □          The estimated transcript fee must be paid in cash or certified funds to the court reporter in advance with any balance due paid to release of the transcript.

                                    ii.        □          The undersigned requests that the transcript fee by waived in forma pauperis.

                        b.         □          There was no hearing, so there is no transcript to request.

            5.         Hearing.

                        a.         □          The undersigned requests a hearing be scheduled before the reviewing judge.

                        b.         □          The undersigned does not request a hearing.

            6.         Under Minn. R. Civ. P. 11, I certify that, to the best of my knowledge:

                        a.         this document is not being presented for any improper purpose, such as to harass or to cause unnecessary delay or needless increase in the cost of litigation;

                        b.         the claims, defenses, and other legal contentions therein are warranted by existing law or by a nonfrivolous argument for the extension, modification, or reversal of existing law or the establishment of new law;

                        c.         the allegations and other factual contentions have evidentiary support or, if specifically so identified, are likely to have evidentiary support after a reasonable opportunity for further investigation or discovery;

                        d.         the denials of factual contentions are warranted on the evidence or, if specifically so identified, are reasonably based on a lack of information or belief; and

                        e.         this document does not include any restricted identifiers and that all restricted identifiers have been submitted in a confidential manner as required by Minn. R. Gen. Prac. 11.

I know that I may be fined or sanctioned by the court if this certification is false.

            7.         Under Minn. Stat. § 358.116, I declare under penalty of perjury that everything I have stated in this document is true and correct.