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PT l;oru~ 961 (Revised 9/23/96) <br /> <br />Minnesota Department of Revenue <br /> <br /> Ai;plica~ io~; for Approval of a New Use of Tax-Forfeited Lands <br /> (;{innesota Statutes, Section 282.01, SubdMsions la through lc) <br /> In ~ ~ o~. County <br /> <br /> Date state deed issued: <br /> (month) (da),) <br /> <br />Ir?al descr y~titm of ?roper~ ~' (tach,de tht-. name of the city/town m which the property is located): <br /> <br />(yearJ <br /> <br />D~sc~ ibc II~e imended pubii, usC ,m' which the property was previously conveyed (be specific, ~elud~g statute or special law <br />scribe the new public usc t'o~ 1}~e property that is berg requested (be specffic, ~clud~g statute or special law references, <br /> <br />Ad ho'ss <br /> <br />S'! ',,'?E O1- MIS:NI:SOTA ) <br /> ) SS. <br /> <br /> (3~ ~,o [-~ ~,~, '~ Yx, being f~st duly sworn, deposes and says that he/she is ~e auto,ed <br />rep[cscotativc of the govern, nentai subdivision (applicant) named here~, ~at he/she has read said application and ~ows the contents <br />fl~c: t~of, and that thc matters ~ rated therein are line and co~ect. <br /> <br /> Name Title <br /> Subscribed and sworn to before me ~s <br /> <br />day of 20 <br /> <br />Notary Public. <br /> <br />My commission expires <br /> <br />Count3,, Minn. <br /> <br />Return appliration to: M!: Department of Revenue · Property Tax Division. Mail Station 3340 · St. Paul, MN 55146-3340 <br /> <br /> <br />