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APPLICATION FOR DEFERMENT OF SPECIAL ASSESSMENTS <br />� To the City Council of City of Arden Hills, Ramsey County, Minnesota. <br />(Applicant) being <br />first duly sworn deposes and states: <br />l. That Applicant is the owner of the following described <br />real estate located in the City of Arden Hills, Ramsey <br />County, Minnesota: <br />2. Pursuant to Minn. Stat. 5435.193, et. seq. and the Arden <br />�� Hills Assessment Manual, AppllCant requests deferral <br />of the payment of special assessment for the <br />Improvement. <br />3. In support of this request, Applicant represents as <br />follows: <br />a. Applicant is over 65 years of age; <br />b. Applicant is permanently and totally <br />� disabled as follows: <br />C. AppllCant's adjusted gross income is <br />S <br />4. Applicant declares that the foregoing information is <br />true and correct and agrees to imnediately inform the <br />Arden Hills City Administrator should any ofthe <br />foregoing information change, and agrees that if the <br />deferral is granted, Applicant will in-mediately upon <br />termination of the deferral pay to the City the <br />deferred assessment with interest. <br />Dated: <br />Subscribed and sworn to <br />�" before me this day <br />— of , 1989 <br />,,,. Notary Public <br />Applicant <br />O-1 <br />