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Application to Repurchase after Forfeiture <br />Applicant Name: <br />Applicant's relationship to the prope <br />Mailing Address �c��o <br />City, State, Zip� <br />Sign <br />N. <br />1 <br />c.ir�� e�- <br />���� �� � �� <br />Phone: �,"�� �(��-'�%a�� <br />E-mail Address: <br />�j�'��•�-i''�- <br />ll <br />Attachment A <br />Date �— � f � � � �� �/ <br />The foregoing instrument was acknowledged before me this y , <br />J� da of��' <br />�_ , <br />NOTARY STAMP/ SEAL <br />Given under my hand and official seal of this <br />��dayof� ��. ��1� <br />, <br />Signature of Notary Public <br />Notary Commissioner Exnires��_�`..�� <br />.:-,..�, A..r,. ..,,..^+., yr.,�t, �..�r....�,: <br />�,�l�; : <br />��'•�, . ..:.. ,;-' ..;„ � OTEL <br />iq �.:, i..�� i.. ;�i �':hi?r"i � <br />�`"' � ���"`� F'UELIC - MINN�SOiA <br />�>`� h��, r;. .,,, � <br />f SSIQN FJ(F'IRES 01/3i r�Q2Q'` <br />`�'�,; ��..,-.� <br />a°.,,. � y..��,... <br />Return application to: Department of Property Records and Revenue, Attn: Tax Forfeited Lands Section, <br />PO Box 64097, St. Paul, MN 55164-0097 <br />