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.: Sri4vliaaiw,, :_lwi a:_:r �ci:•�....4!;�. r. :u ... .. •i:.. .i <br /> - . - . .: 2. <br /> �. C OSSB: <br /> miles Total • <br /> TOTAL 2XILEAGE COSTS: S <br /> -- A=otnt <br /> Date' <br /> Char ad <br /> TOTAL pARMG COSTS: � <br /> ` TOTAL STl�T�T: <br /> The undersigned Aereby wears and Cvicesl an 'costs,, s and ithat erms <br /> or incur the above • X&fa enced se. <br /> statemeist• is accurate and made in accordance with Rule 10.02 of the <br /> klennepin County District Court Rules. <br /> Address <br /> nature o Commlc over., Str t <br /> Ezp over ID f or <br /> lty, State, Zip Coda <br /> S f <br /> ep one Number <br /> Page 2 of 2 <br />