Brown County, MN · Brown County
Affidavit for Restitution
This affidavit lets a crime victim report financial losses or property damage and submit supporting receipts or estimates to the court administrator.
At a glance
- Issued by
- City of Brown County · Brown County, Brown County, Minnesota
- Notarization
- Not required: file this form without a notary.
- Official source
- browncountymn.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
Use this affidavit to report losses or property damage, theft, or destruction attributed to a defendant in a criminal case. It asks for itemized values, insurance information, and the signer’s contact details, and allows additional sheets and supporting estimates or receipts. The form says to complete and return it to the court administrator.
Who needs it
A person reporting losses or property damage caused by a defendant in a criminal case can complete and return this affidavit to the court administrator.
How to submit it
Return the completed affidavit to the court administrator, as the form directs; it does not provide an address, email, portal, or fee.
About notarization
This affidavit is signed without a notary; the signer declares under penalty of perjury that the statements are true and correct.
How to submit this form
- 1
Download the Affidavit
Download the Affidavit for Restitution PDF.
- 2
Complete the Form
List each loss or damaged, stolen, or destroyed property item and its value, then provide insurance and contact information.
- 3
Gather Supporting Documents
Attach estimates or receipts; attach another sheet if necessary.
- 4
Sign and Return It
Sign and date the affidavit, then return it to the court administrator.
Frequently asked questions
- Do I need a notary for the Affidavit for Restitution?
- No. The affidavit has no notary block. The signer declares under penalty of perjury that the statements are true and correct.
- How do I submit the Affidavit for Restitution?
- Complete and return it to the court administrator. The form does not give an address, email, portal, or fee.
- What information does the affidavit ask for?
- It asks you to list losses or damaged, stolen, or destroyed property and its value, provide insurance details, and include your name, address, and signature.
- Should I attach receipts or estimates?
- Yes. The form instructs you to attach estimates or receipts and says you may attach another sheet if necessary.