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HOUSING IMPROVEMENT AREA <br /> APPLICATION FOR DEFERRAL OF FEES <br /> STATE OP MINNESOTA ) <br /> COUNTY OF RAMSEY ) Date ---y_,~~ - , 20 <br /> TO: City of Little Canada <br /> I, the undersigned, declare under penalties of perjury: ( _ <br /> That I reside at - ~ 'Y 1 C" + C ` l <br /> That I am at least 65 years of age and that the date of my birth is , <br /> Or <br /> That I am retired by virtue of a permanent and total disability. Yes No <br /> And <br /> That my household income falls within the "low to moderate" income range pursuant to current Federal <br /> G delines: l Person - $43,050; 2 People - $49,200; 3 People - $55,350. (Copy of Tax Return Attached.) <br /> Or ~ <br /> <br /> ether special circumstances as described on the reverse side of this form. <br /> That I am the owner of the property de~scr'i`b~ed as: <br /> Property Address: ~ f~ ~ _ "CYl ~1 ~ ~ <br /> Property IdentificationNo.: (J 7 _~~-,~~ay l bo~G>S <br /> That my interest in the ownership of the above property was acquired on <br /> and is as follows: <br /> 1. Sole ownership (Enter yes, if applicable) V~~ <br /> 2. Joint tenancy, held with <br /> 3. Other undivided interest (specify) <br /> That on January 2, 20 or June 1, 20 I owned and occupied the above property as my homestead and <br /> such occupancy began on _ __`~~a- ~ <br /> That the installments for HIA improvements on the fees duly adopted in by resolution of the Council of the City <br /> of Little Canada as of , 20 ,which have been allocated against the subject property would <br /> create undue personal hardship on my behalf and I respectfully request that payment be delayed and that such <br /> installments be so deferred until one of the following would ocew•: <br /> I . Death of the owner (provided by surviving spouse, if any, is not eligible for <br /> deferment); <br /> 2. Sale, transfer or subdivision of the subject property; <br /> 3. Loss of homestead status of subject property; <br /> 4. Change of circumstances of owner resulting in there no longer being a hardship as <br /> defined previously. <br /> I understand that interest will accrue on the principal aiance of~h~ fees]evie again-st my property as a result of <br /> any deferment granted. <br /> _ _ <br /> l <br /> Sign d: <br /> G' ~ _ ~ <br /> <br />