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WASHINGTON COUNTY ASSESSMENT DIVISION <br />Statement of Facts: <br />Applicant's Request: <br />Please abate the special assessment for the <br />amount to be abated is $436.22 <br />A change in property classification resulted in an erroneous billing. The <br />Applicant's Si nature., -- -�— �_— Date: <br />Note; Minnesota Statute's 1988, Section 609.41, "Whoever, in making any statement, oral or written, which is required or authorized by <br />law to be made as a basis of imposing, reducing, or abating arty tax or assessment, intentionally makes any statement as to any material <br />:natter which the maker of the statement knows is false may be sentenced, unless otherwise provided by law, to imprisonment for not more <br />than one year or to payment of a fine of not more than $3,000.00 or both. <br />Note: Must include City/Township resolution for reductions on assessments <br />Note, Must include Fire report for Local Option Disaster Credit <br />1 Rev 5/1€1 <br />APPLICATION FOR ABATEMENT - GENERAL.. FORM <br />(M,S.) 375.192 <br />CLASSIFICATION / DISASTER CREDIT / SPECIAL ASSESSMENTS <br />Worksheet <br />Assessment Year: 2011 <br />Payable Year: 2012 <br />APPLICANT <br />Owner's €wine (please print or type) Sac. Sec. /Fed 1D <br />Phone Cell <br />Corporation M <br />Owner's Name <br />Soc. Sec. /Fed I <br />3 <br />Phone cell <br />Owner's Nainc <br />Soc. Sec. /Fed ID <br />l <br />Phone <br />Cell <br />Owner's Mailing Address <br />Property Address (if different from <br />mailing address) <br />6374 Windbreak Trail <br />DACE Acres 2nd Addition Lot 14 <br />City <br />State Zip <br />City <br />State Zip <br />Lake Elmo <br />MN 65442 <br />Lake Elmo <br />MN 55042 <br />DESCRIPTION <br />OF PROPERTY <br />Property ID Number <br />MP Number <br />09.025.21.13.0049 <br />Legal Description of Property <br />City or Toumship <br />School District # TAG <br />DACE ACRES 2nd ADD Lot 14 Subdivision Cd 37546 Lake Elmo <br />622 <br />ASSESSOR'S ESTIMATED MARKET VALUE <br />®ri al: <br />Land EMV <br />improvement EMV Total <br />Classification <br />Revised: <br />Land EMV <br />Improvement EMV Total <br />Classification <br />Statement of Facts: <br />Applicant's Request: <br />Please abate the special assessment for the <br />amount to be abated is $436.22 <br />A change in property classification resulted in an erroneous billing. The <br />Applicant's Si nature., -- -�— �_— Date: <br />Note; Minnesota Statute's 1988, Section 609.41, "Whoever, in making any statement, oral or written, which is required or authorized by <br />law to be made as a basis of imposing, reducing, or abating arty tax or assessment, intentionally makes any statement as to any material <br />:natter which the maker of the statement knows is false may be sentenced, unless otherwise provided by law, to imprisonment for not more <br />than one year or to payment of a fine of not more than $3,000.00 or both. <br />Note: Must include City/Township resolution for reductions on assessments <br />Note, Must include Fire report for Local Option Disaster Credit <br />1 Rev 5/1€1 <br />