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1 <br />WASHINGTON COUNTY ASSESSMENT DIVISION <br />APPLICATION FOR ABATEMENT - GENERAL. FORM <br />(M.S.) 375.192 <br />CLASSIFICATION 1 DISASTER CREDIT 1 SPECIAL, ASSESSMENTS <br />Worksheet #: <br />Assessment Year: <br />2011 <br />Payable Fear: <br />2012 <br />APPLICANT <br />Owner',; Name (please print or type) <br />Soc. Sec. /Fed ID <br />Phone <br />Cell <br />Melissa & Ryan Ptannenstein <br />Owners Name T <br />Soc. Sec. /Fed ID <br />Phone <br />Cell <br />Owner's Name <br />Soc. Sec. lFed ID <br />Phone <br />Cell <br />Owner's Mailing Address <br />Property Address (if different from availing address) <br />PO Box 25066 <br />3572 Kelvin Court <br />City <br />State <br />Zip <br />CityState <br />Zip <br />Woodbu <br />�N <br />55125 <br />Lake Elmo <br />ISN <br />-] 55042 <br />DESCRIPTION OF PROPERTY <br />Property ID Number <br />MP Number <br />14,029.21.23.0006 <br />Legal Description of Property <br />City or Township <br />School District# <br />TAG <br />Park Meadows Lot 3 Block 1 Subd Cd 02225 <br />Lake Elmo <br />834 <br />ASSESSOR'S ESTIMATED MARKET VALUE <br />Revised: <br />Land EMV I Improvement EMV I Total <br />Applicant's Statement of Facts: <br />Applicant's Request: <br />Please abate the special assessment for Jelin cent utilitise in the amount of $190.00. This amount was assessed in error. -- — – <br />Applicant's Signature: � J ✓� " Date: 312 fo // Z <br />Note: Minnesota ,Statute's 1988, Section 609.41, "Whoever, in snaking any staternent, oral or written, which is required or authorized by <br />ra,:. to t, .} ono n i,ac — a3—tin ., f. yr not f—finnnlly —alrpc nnxv etnfwmwnf ne to n• x, — t—;01 <br />x.. ry ..w vv xaa,+.......w ,...cw.w v....r,w.a ..�„ .,,+..v...6, a c.vw....� w.� AAAA..... ....�............... ..................� ...............� ................ »., ... »..� ............. <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 />l than one year or to payment of a fine of not more than $3,000.00 or both. <br />Note: Must include City[fownship Resolution for reductions on assessments <br />Note: Must include Fire report for Local Option Disaster Credit <br />Rev 5/14 <br />