03-18-09 HIA Agenda - Laserfiche WebLink

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HOUSING IMPROVEMENT AREA APPLICATION FOR DEFERRAL OF FEES STATE OF MINNESOTA ) COUNTY OF RAMSEY ) Date , 20_ TO: City of Little Canada I, the undersigned, declare under penalties of perjury: That I reside at That I am at least 65 years of age and that the date of my birth is , Or That I am retired by virtue of a permanent and total disability. Yes No And That my household income falls within the "low to moderate" income range pursuant to current Federal Guidelines. (Copy of Tax Return Attached.) Or Any other special circumstances as described on the reverse side of this form. That I am the owner of the property described as: Property Address: Property Identification No.: That my interest in the ownership of the above property was acquired on and is as follows: 2. 3. Sole ownership (Enter yes, if applicable) Joint tenancy, held with Other undivided interest (specify) That on January 2, 20_ or June 1, 20_ I owned and occupied the above property as my homestead and such occupancy began on That the installments for HIA improvements on the fees duly adopted in by resolution of the Council of the City of Little Canada as of , 20_, which have been allocated against the subject property would create undue personal hardship on my behalf and I respectfully request that payment be delayed and that such installments be so deferred until one of the following would occttt•: 1. Death of the owner (provided by surviving spouse, if any, is not eligible for deferment); 2. Sale, transfer or subdivision of the subject property; 3. Loss of homestead status of subject property; 4. Change of circumstances of owner resulting in there no longer being a hardship as defined previously. I understand that interest will accrue on the principal balance of the fees levied against my property as a result of any deferment granted. Signed: