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WASHINGTON COUNTY - ASSESSMENT DIVISION Form4 Revised 3/2000 <br />Ir <br />Vorksheet# APPLICATION FOR ABATEMENT - GENERAL FORM (M.S. 375.192) <br />CLASSIFICATION DISASTER CREDIT / SPECIAL ASSESSMENTS <br />County of. For property assessed {year) 2008 <br />WAS!!�TON <br />and payable in (year) 2009 <br />Please print or type <br />Applicant's Name Citv of Lake Elmo Applicant's Mailing Address <br />Applicants Social Security Number 3800 Laverne Ave N. <br />Telephone (work) 651 777-5510 Lake Elmo MN 55042 <br />Telephone (home) <br />Street Address (if different from above) Ref eranee 5715 Highlands TrI N. <br />Lake Elmo ITT .55042 <br />Description of Property <br />Property,IDNumber 04-029-21-23-0004 MP Number <br />SchoolDistrict# City orTownshlpName �1�11 ict 1, <br />Legal Description of Property I D;:s �cO or Township Name 0 C <br />Demontreville Highlands 6th Add t8:32 C�ito �fLak�eElm�o� <br />Lot 001 Blk 003 <br />10 Assessor's Estimated Market Value <br />Land Structure Total $ Class <br />Applicant's - �teinenTofTia_c - Unpaid Utility Specail Assessment submitted with incorrect <br />PIN # <br />Request: Please remove the Special Assemmintit Unpaid Utility for: <br />PIN # 04-029-21-23-0004 # 2608053 2009 <br />Name: James-Edward Thiens Class: Special Assessment <br />5715 Highlands Trl N. Type: C-Delq Util <br />Lake Elmo MN 55042 <br />icaut's Signature; <br />3Date:4/01/2009 <br />