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: __________________________