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WASHINGTON COUNTY ASSESSMENT DIVISION <br />APPLICATION FOR ABATEMENT - GENERAL .FORM <br />CLASSIFICATION / DISASTER CREDIT / SPECIAL ASSESSMENTS <br />,jrksheet #: Assessment Year: <br />Payable Year <br />APPLICANT <br />(M.S.) 375.192 <br />2091 <br />Owner's Name (please print or type) <br />Garold & Ma <br />aFelland <br />Soc. Sec. /Fed ID <br />Phone <br />Cell <br />Owner's Namem�WSoc, <br />Sec, T d I Phone Cell <br />E <br />Owner's Name <br />1 <br />Soc. Sec. /Fed ID Phone Cell <br />Owner'sMailin g Address <br />Properly Address (if different from mailing address) <br />2377 Legion Ln N <br />City <br />State Zip <br />City <br />State <br />Zip <br />Lake Elmo <br />SIN 55042 <br />Lake Elmo <br />iNN <br />55042 <br />DESCRIPTION OF PROPERTY <br />Property ID Number MP Number <br />24.029.21.42.0004 <br />Legai Description of Property City or Township School District # TAG <br />EDEN PARK Lot 4 Block 1 Subdivision Cd 37180 Lake Elmo 622 <br />ASSESSOR'S ESTIMATED MARKET VALUE <br />Original: <br />Land EMV <br />Revised: <br />Applicant's Statement of Facts: <br />Improvement EMV <br />Total <br />Classification <br />Applicant's Request: <br />Please abate the $1,750 street assessment that was assessed In 2010 to begin payment in 2011 as It was assessed in error. Their payment was <br />.... <br />received 9/2110 and they should have been removed from the list but were not The City of Lake Elmo refunded the Fellands for the amount <br />.......I ...... ......... ... _.._.......... ........... . <br />withheld in error to 2011 {$283 00) and the County needs to remove this from their tax roll as soon as possible. <br />._-_...... ... ... ....... <br />licant's Signature: <br />Bate: 4J �,/(, <br />Note: Minnesota Statute's 1998, Section 609.41, "Whoever, in making any statement, oral or written, which is required or authorized by <br />' v to be made as a basis of imposing, reducing, or abating any tax or assessment, intentionally makes any statement as to any material <br />Ler 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 />I Rev 5/10 <br />