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APPLICATION FOR DEFERMENT OF SPECIAL ASSESSMENTS <br /> • To the City Council of St Anthony, Minnesota. <br /> Willard N. Mohne e Pone• _i Applicant ) being first duly <br /> deposes and states: <br /> 1. That Applicant is the owner of3 the following d Avenue l N.E. <br /> estate located in the City <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 /> O ,applicant's adjusted gross income is $_L3 ,7 0 2 .8 0 <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, Apprcant will <br /> immediately upon termination of the deferral pay to the City the deferred assessment <br /> with interest. <br /> Dated: February 17 , 1994 Applicant <br /> Subscribed and sworn to <br /> before me this 17thday <br /> of February , 19 94 <br /> Notary Public <br /> '91 <br /> CONNIE J.KROEPLIN <br /> _. NOTARY PUBLIC•M:N.1MTA <br /> HENNEPIN COUNTY <br /> My Comm Erp A;� ..5.IC'--3 Z' <br /> xo nr-n"•....mow►• <br />