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IV Application for Withdrawal of Wetland Credits Ed. from the Minnesota Wetland Bank 4. Withdrawal Information To be completed by seller of credits (account holder). Bank Service Area: 7 Account Number: 1515 County: Anoka Number of Credits to Cost of Purchased CreditSubgroupPlant Community Type Cost(acreer jredit be Withdrawn(acre) Credits acre--ft2/43560 (cost per credit x number of credits) A Wet Meadow $54450.00 0.0793 $4317.89 $0.00 $0.00 $0.00 TOTAL 0.0793 If TOTAL does not calculate,right click, Update Field Enter County Fee Table: www.bwsr.state.mn.us/wetlands/2014 Fee Schedule-adfrom Table(county of 6.5%of sale price seller's bank) ---------------------------- 2941.00 Above TOTAL x Transaction Fee(choose either amount) County Fee f $233.22 Attach check payable to Minnesota Board of Water and Soil Resources. By signature below I seller and holder of the aforementioned account in the State of Minnesota Wetland Mitigation Bank certify that: 1) The credits described in this application have been sold to the credit user or will be used for my own project; 2) 1 have received payment in full from the buyer(if applicable); 3) The credits described in this application have not been sold or used in any way to mitigate wetland losses other than for the pro. and location identified in the wetland impact information block on the previous page; 4) The credits described in this application should be withdrawn from my account;and 5) 1 will not have a negative balance of credits after the subject credits are debited from my account Seller Name(print): Steve Strandlund Seller Signature: Date: Seller e-mail": stevesr@dirtworksmn.com 1. The account holder of the credits is responsible for submittal of this form, containing signatures,to the BWSR Wetland Bank Administrator so the affected account can be properly debited. 2. No impacts to any wetland or other water resource may commence until the credits have been debited and a copy of this form, with stamped debit date,has been received by the regulatory authority(ies),the account holder, and the credit user. When this form is completed and all required signatures are obtained, send with the fee check to: Wetland Bank Administration Minnesota Board of Water and Soil Resources 520 Lafayette Road North Saint Paul, MN 55155 Disclaimer:any transaction in the wetland banking system is public information. Rev 6/9/2014 BWSR Application for Withdrawal of Wetland Credits Form Page 2 of 2 C:\Users\tbender\AppData\Local\Microsoft\Windows\Temporary Internet Files 2 2 tent.outlook\9NJG4319\application_for_withdrawal_of_credits form 11.25.14.docx