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Alft 4& <br />It <br />APPLICATION FOR DEFERMENT OF SPECIAL ASSESSMENT <br />To the City Council of St. Anthony,, Minnesota. <br />George R. Erickson (Applicant) being'first duly deposes and states: <br />Dated: <br />1. The Applicant is the owner of the following described real estate located in the <br />City of St. Anthony, Minnesota: <br />2534 — 30" Avenue 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 Improvement Project. <br />3. In support of this request, Applicant represents as follows: <br />IN III <br />NMI' <br />a X M <br />b. Applicant is permanently and totally disabled as follows: <br />L <br />C. 001 N &Z <br />1 10111 <br />4. Applicant declares that the foregoing. information is true and correct and agrees <br />to immediately inform the City of St. Anthony should any of the foregoing <br />information changes., and agrees that if the deferral is granted, Applicant will <br />immediately upon termination of the deferral pay to the City deferred <br />assessment with interest, <br />Applicant <br />Subscribed and sworn to before me this day of f 20 <br />Notary Public <br />10 .0-0-010 F P i 00" <br />25 <br />