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WASHINGTON COUNTY ASSESSMENT MVISIt3N <br />APPLICATION FOR ABATEMENT - GENERAL FORM (M.S.,' 375 192 <br />CLASSIFICATION I DISASTER CREDIT / SPECIAL ASSESSMENTS <br />Worksheet #; Assessment Year: 2005 <br />Payable Year; 2012 <br />APPLICANT <br />Oisner-s Mattie (please print or type) Soc Sec. /l=et# IC Phone Cel! <br />i l <br />Jo Ce L iStOrkam <br />Owner's Name Soc Sec, fl=ed Ill Phone Cell <br />I i <br />Judy Garscia <br />Qwncr s Name ... _ ... Soc. Sec. /fed ID i Phone Cell <br />Owner's Mailing Address Property Address (if different from mailing address) <br />8017 5011 Street N <br />City _. _._. �_ —.-----State Zip I City state Zip <br />Lake Elmo N 55042 <br />11P..Q RIPTION OF PROPPRTY <br />Praperry II3 hfurr€ber <br />MF Namber <br />09.029.21.22.0013 <br />Legal Description of Property _ <br />City or Township School District # 1 TAG <br />Lane's Demontreville Country Club Lot 755 Subdivision Cd 37445 <br />lake Elmo 834 1 <br />ASSESSOR'S ESTIMATED MARKET VALUE <br />Original, <br />[_and EMV Improvement EMV Total Classification <br />i <br />i <br />Revised: <br />Land EMV Improvement EMV Total Classification <br />Applicant's Statement of Facts: <br />Applicant's Request: <br />Please abate the remainder of the Hili Trail and 60th Street Improvement assessment in the amount of $901.36. This was paid by the taxpayer in <br />Taxpayer should not be assessed for this improvement in the future <br />Applicant's Site�re . `t ` — Bate: t �I �l Z <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 any tax or assessment, intentionally makes any statement as to any material <br />matter which the maker of the statement Mows 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 X3,000.00 or both_ <br />Note: Must include City/Township Resolution for reductions on assessments <br />Note: Must include Lire report for Local Option Disaster Credit <br />1 Rev 5/7.0 <br />