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APPLICATION FOR DEFERMENT OF SPECIAL ASSESSNIE-N-M <br /> To the City Council of St Anthony, Minnesota. <br /> Conrad & Dorothea Kjeldahl (Applicant) being first duly <br /> deposes and states: <br /> 1. That Applicant is the owner of the following described real estate located in the City <br /> of St Anthony, Minnesota: 3216 - 32nd Avenue NE <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 /> 00 Cze <br /> ('Wn rid is evr. <br /> C. Applicant's adjusted gross income is $ 12,144-90 <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, Applicant will <br /> immediately upon termination of the deferral pay to the City the deferred assessment <br /> with interest. <br /> Dated: <br /> -'— A plicant <br /> Subscribed and sworn to <br /> before me this_J_day <br /> of 19 F <br /> &WA KATHERINE J.HAYES <br /> NOTARY F4JX1C-6 NNIESOTA <br /> HENNEPIN COUNTY <br /> No Public 4 �4►�Fjres Apr•12,1M <br /> r <br />