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<br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Declaration <br /> <br />Residential Facility Permitted by Minnesota Statues 462.357, Subd. 6a through 8 <br /> <br />Date: _________________ <br /> <br />Licensed Operator Name <br />: ________________________________ <br /> <br />Office Address: <br /> ______________________________________________________________ <br /> Street City State Zip Code <br /> <br />Phone:____________________________________________________________________ <br />_ <br /> Home Work Fax Email <br /> <br />Location of Residential Facility: <br /> _______________________________________________ <br /> Street Address <br /> <br />Legal Description of Property: <br /> __________________________________________________ <br /> <br /> <br />County Property Identification Number: <br /> __________________________________________ <br /> <br /> <br /> <br /> <br /> 1 <br /> <br />