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MDEPARTMENT <br />OF REVENUE <br />Conditional Land Use Review Form <br />Email to: state.deeds.mdor@state.mn.us <br />Deed Numhet <br />0173957 <br />Appl[r,.ant <br />City of Mounds View, Ramsey County <br />Conditional Use Granted by the Deed <br />Wetlands preservation <br />Issuance Date <br />8/31/1990 <br />a Is the property listed on the deed still owned by the governmental subdivision to which it <br />was originally conveyed? <br />a� <br />c <br />o yes No, call the State Deeds line at 651-556-6085 <br />Is the property still being used for the purpose listed on the deed? <br />Efyes <br />❑ No. If no, which of the following options will you pursue? <br />cIncorporate the property and its authorized public use into a <br />a` formal plan <br />w <br />0 <br />Reconvey the property to the State of Minnesota (use PT <br />Form 975 or 976) <br />F1 Purchase the property at market value after reconveying it to <br />the State of Minnesota <br />4 <br />I certify that the above information is true and correct. <br />; �.—1 <br />i itie <br />IN <br />Mv-)j <br />Rev. (V19) <br />