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<br />. <br /> <br />. <br /> <br />. <br /> <br />~ <br /> <br />226271 <br /> <br />APPLICATION FOR DEFERMENT OF SPECIAL ASSESSMENTS <br /> <br />To the City Council of City of Elk River, Sherburne County, <br /> <br />Minnesota. <br /> <br />~ 0 '5,...e D'r-, <br /> <br />(" ~ fY\ VV\ -e,V" M a f\ <br />, <br /> <br />(Applicant) being, <br /> <br />first duly sworn deposes and states: <br /> <br />1. <br /> <br />That Applicant is the owner of the <br />real estate located in the City of <br />. Sherburne County Minnesota: \ \ S. ~ <br />~ ~ ~ \. A .{:l \0-.-\1"\ d <br /> <br />following described <br />Elk River, <br />OIl:) - DOO \E;<E: ~ <br />, <br /> <br />2. Pursuant to Minn. Stat. S435.l93, et. seq. and Elk <br />River Code of Ordinances S1404, Applicant requests <br />deferral of the payment of special assessment for the <br />~..Q..\....V'-l.Y I .~ 0..-l:>U -LV'<-, ~ I'\\- Improvement. <br /> <br />3. In support of this request, Applicant represents as <br />follows: <br /> <br />~ Applicant is over 65 years of age; ~~ <br /> <br />b. <br /> <br />Applicant is permanently and totally <br />disabled as follows: <br /> <br />c. Applicant's adjusted gross income is <br />$ ~ \~Joc<o · <br /> <br />4. Applicant declares that the foregoing information is <br />true and correct and agrees to immediately inform the <br />Elk River City Administrator should any of the <br />foregoing information change, and agrees that if the <br />deferral is granted, Applicant will immediately upon <br />termination of the deferral pay to the City the <br />deferred assessment with interest. <br /> <br />Dated: ~..c>~+. ~D \S~'i<. <br /> <br /> <br />Subscribed and sw~n to <br />before me this ~() day <br />of ~.p{.e~I'A-- ---; 1988 <br /> <br /> <br />Nota <br />e LORI A..K:IHNSON <br />NOTARY ..-.s.a.t.'\."lESOTA <br />SHEABURNECC~itN <br />. '; ~ "'CDI!W.\I~'-""':::' ;'I,tl::3 <br />.~~ <br />