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<br />. <br /> <br />. <br /> <br />. <br /> <br />... <br /> <br />226272 <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 />lJ () r (.s <br /> <br />---- <br />I ro_<"k <br /> <br />(Applicant) being, <br /> <br />F <br /> <br />first duly sworn deposes and states: <br /> <br />1. That Applicant is the owner of the following described <br />real estate located in the City of Elk River, <br />Sherburne County Minnesota: ~r /6 ~ /1 .& /CJC-* / <br />~A~j'Y'u.'ts. ;C) d.(I" II S'- ~qlJ -l) /t:'J Ih~ .I <br /> <br />2. Pursuant to Minn. Stat. S435.l93, et. seq. and Elk <br />River Code of Ordinances Sl404, Applicant requests <br />deferral of the payment of special assessment for the <br />ma..'n -S+-ree+ Improvement. <br /> <br />3. In support of this request, Applicant represents as <br />follows: <br /> <br />(9 <br />C9 <br /> <br />Applicant is over 65 years of age; <br /> <br />Applicant is permanently and totally <br />disabled as follows: Le.;t4//Y A /'nrl <br /> <br />. <br /> <br />c. Applicant's adjusted gross income is <br />$ ~. 'lIt.! . <br />. <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: <br /> <br />/oklf.v <br /> <br />A~~~ 9 ~{n 4/JL <br /> <br />Subscribed and s;7rn to <br />befo~ me this day <br />of /(1~ ' 1988 <br /> <br />~~ (). ~7' <br />Notary Public ;r <br /> <br />~ SANDRA A. lHACKERAY <br />NOTARY PUllllC. MINNESOTA <br />SHEP 'iNE COUNlY <br />~. My Co~ ; Expm J\n I,tllt <br />W.'.JVtPN.,J"^..~ '. ;,,"; ~,"r.' <br />