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APPLICATION FOR DEFERMENT OF SPECIAL ASSESSMENT <br />To the City Council- of St. Anthony,, Minnesota, <br />Mildred M. Demcho (Applicant) being first duly deposes and states: <br />1, The Applicant is the owner of the fol -lowing. described real estate located in the <br />City of St. Anthony, Minnesota: <br />2501 - 30'h A venue NE <br />St, Anthony, MN 55418 <br />2. Pursuant to MN Stat, § 435.193,,'et seq, and the St, Anthony Assessment Policy, <br />applicant requests deferral of the payment of special assessment for the 2006 <br />Street Project .Improvement <br />l <br />I In support of this request, Applicant represents as follows: <br />; V: a , I " �- ­. 5 fim . V <br />a <br />it `�, ffilr.1-r*1001t. <br />b. Applicant is permanently and totally disabled as follows: <br />• C. <br />PRI N. -M .1 x -a' 01 11 <br />• <br />4. Applicant declares that the foregoing information is true and correct and agrees <br />to immediately inform the St. Anthony City Manager should any of the <br />foregoing information -changes,, and agrees that if the deferral is granted, <br />Applicant will immediately upon . termination of the deferral pay to the City <br />deferred assessment with interest, <br />.4 <br />Ar <br />Dated: <br />Applicant <br />Subscribed and sworn to before me this 15 day Of 20 <br />�r.ca� <br />Notary Public <br />My C. WVNft EV 1-31-2010! <br />110 <br />20 <br />