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PT Form 96] (Revised 9/23/96) <br /> <br />Miunesotn Department of Revenue <br /> <br /> In <br /> <br />Nan,e of governmental subdivision (applicant): <br />Mail#,g address of applicant: ~ b- ~ ~ ~. <br /> <br />State deed number: ~ % '1 2. ri o[ <br /> <br />Application for Approval of a New Use of Tax-Forfeited Lands <br /> (Minnesota Statutes, Section 282.01, Subdivisions la through lc) <br /> ~ ~, o¼~ County <br /> <br /> Date state deed issued: <br /> (month) (day) <br /> <br />(yeard <br /> <br />Legal description of propero, (include the name of the city/town in which the pro)erty ~ located): <br /> <br />Describe the iutended public use for which the property was previously conveyed (be specific, including statute or special law <br /> <br />Describe the new public use for the property that is being requested (be specific, mctuding statute or special law reference& if <br /> <br />THIS INSTRUMENT WAS DKAZTED BY: <br /> <br />Name <br /> <br />Address <br /> <br />STATE OF MINNESOTA ) <br /> <br />County of ~,.o1~. ~ ) <br /> <br /> 5&~o~ ~',~,~:.2.~; \'x', being first duly sworn, deposes and says that he/she is the authorized <br />representative of the governmental subdivision (applicant) named herein that he/she has read said application and 'knows the contents <br />thercof, and thru the mat~ers stated therein are true and correct. <br /> <br /> Name Title <br /> Subscribed and sworn to before me tiffs <br /> <br />day of 20 <br /> <br />Notary Public, <br /> <br />My commission expires <br /> <br />Count5,, Minn. <br /> <br />Relurn application to: M~' Department of Revenue . Property Tax Division i Mail Station 3340 . St. Paul, MN 55146-3340 <br /> <br /> <br />