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13065 Orono Parkway <br />Elk River, MN 55330 <br />2014 City of Elk River <br />Franchise Fee Rebate Application Form <br />Applicant Name: <br />Property Address: <br />Mailing Address (if different): <br />PID # (if known): <br />Phone Number: <br />Applicant's Certification <br />By my signature below, and as the applicant for this franchise fee rebate, I represent and agree that: <br />a) I understand that franchise fee rebates are only available to properties which are currently paying <br />street improvement assessments; b) I understand that only one application per property is eligible; <br />c) I understand that I must be the owner of the property and provide proof of the franchise fee <br />payments; d) I certify that I have been paying the franchise fee for the property for the rebate <br />period; e) I understand the City of Elk River will be verifying all applications. <br />Property Owner <br />Date <br />Mail this application along with copies of a November or December gas bill and electric bill <br />showing the franchise fees to: <br />City of Elk River <br />Attn: Franchise Fee Rebate <br />13065 Orono Parkway <br />Elk River, MN 55330 <br />* *2014 Rebate Applications are due by January 31, 2015. Checks will only be <br />issued once per year in March. <br />Phone: 763.635.1000 <br />Fax: 763.635.1090 <br />www.elkriverrnn.gov <br />P R N E R E R R 1 <br />NATUREI <br />