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Office of the Minnesota Secretary of;State <br />Legal Newspaper Status Application <br />Mlniterota Statutes, Clt, yptp' 33/A.02 <br />Must be filed between September 1 and Dacember31, each year <br />Filing Fees $ZS.00 <br />Please read the inattadtone before completing this form. <br />1. Current Name and Known Office oPlssuo Address ofNe4epar. <br />Anoka County UntonHerald <br />4101 Coon Rapids Blvd <br />Coon Rapids, MN 55433 <br />2, • jP ;1istwthe Hew name and/or address of kn own o1i co of issue: <br />i <br />Name of Newspaper: <br />Street Address: <br />(Muss be a complete street address or rural route and rural route box number) <br />City: ,.......... State: hiti Zip Code: <br />3. County of Known Office alum (Required) .�.,. � A a <br />4. Legal Newspaper Phone Number: (Required) 76. 3/-i) _ <br />(Area Code) Phone Number <br />S. Name and daytime phone number ofcontact person: <br />RAIN <br />4g b A gTA <br />�1� <br />SEP 22021 S <br />t".04, <br />Seoreten of State <br />w w ■ <br />Contact Nam = Daytime Rhone Number <br />6. Email Address for Owl Notices <br />wr* <br />Enter an email address to which the Secr <br />etary of State can f+ward official notices required by law and other notices: <br />&Mail Address: ,i ..r ' t & + -(!e:11-1.1 <br />7. This legal newspaper fifes that it has complied with all lftho requirements ofManmade Statutes, section 331A.02. <br />8. I, the undersigned certify that I am signing this document as the person whose signature is required or as agent of the <br />person(s) whose signature would be required who has autho me to sign this document on hialher behalf, or In both <br />capacities. I further cattily that I have completed all requi ` fields, and that the information in this document is true and correct <br />and in compliance with the applicable chapter of Minnesota gtatutes. I understand that by signing this document I am subJe►ct to <br />the penalties of petury as set forth in Section 609A8 as if I Hd signed this document under oath. <br />or <br />Signature o Authorised Representative (Required) Date <br />rnternarPc mdLegaINc r M 1c+atlor t{aitrggt it 11 v.7/IO2O16 <br />