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APPLICATION FOR DEFERMENT OF SPECIAL ASSESSMENTS <br /> To the City Council of St Anthony, Minnesota. Applicant) being first duly <br /> Willard N. Mo r - 266 <br /> e ep one: <br /> deposes and states: <br /> I. That Applicant is the owner of the following l estate located in the City <br /> 3201 d Avenue N E <br /> of St Anthony, Minnesota. <br /> 2. Pursuant to Minn. Stat. S435.193, et. seq. and the St Anthony Assessment Policy, <br /> Applicant requests deferral of the payment of special Assessment for the <br /> 1994 Street Reconstruction Improvement. <br /> 3. In support of this request, Applicant represents as follows: <br /> a, Applicant is over 65 years of age; <br /> b. Applicant is permanently and totally disabled as follows: <br /> cU, applicant's adjusted gross income is $ 13 ,702-80 <br /> 4. Applicant declares that the foregoing information is true and correct and agrees to <br /> immediately inform the St Anthony City Administrator should any of the foregoing <br /> information change, and agrees that if the deferral is granted, AppCcant will <br /> immediately upon termination of the deferral pay to the City the deferred assessment <br /> with interest. <br /> Dated: February 17, 1994 <br /> Applicant <br /> Subscribed and sworn to• <br /> before me this 17thday <br /> of February , 19 94 <br /> • Notary Public <br /> CONNIE J.KROEPLIN <br /> NOTARY PUBLIC• A7 IVSSOTA <br /> ® HENNEPIN CCUNTY <br /> M,Corse Eip.A; Ic_; r <br />