STATE OF MINNESOTA

COUNTY OF	DISTRICT COURT

______________ JUDICIAL DISTRICT

DIVISION:

CASE TYPE:

,

Plaintiff,

v.

,

Defendant.

NOTICE OF REQUEST

FOR JUDGE REVIEW

Pov. Law Form No. JR-1 (September 2017)

Case No.

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.

Date

Signature
County and State Where

Document Is Signed

County: _____________________________

State: _______________________________	Name: ______________________________

Address: ____________________________

City, State, Zip: ______________________

Telephone: __________________________