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1 <br />HAY-2B-2eB3 14:30 □niELING CX14TRQL BDPRD 6516394073 P.03/^9 <br />LO220 - Applieartioh for Exompt Pormit Ftg*2of2 <br />LOOM Unttof Oovonunent AcknowtodonMnl <br />dlyimi>flBntw»4>pM Mliow. <br />On behtf or ttw d|yJ iK^moiMlido* ttilt ^ipfc <br />ClMck th« action tliat <br />Um epir la taUnfl on llito appOeaVon. <br />PI'Hio ely ^iprawt 0w appicaiion wKh no <br />LJ «nMna eofiod. <br />n’fhoctyapproMaa>ianppioaion<»iha30day <br />IJ walHno paitod, and iPbwB ihoBnnI to iMuo a <br />pefml oRar SO daofo (60 days for a flrat daw <br />cRy). <br />QTliaclyd Owappication. <br />Prtntnamterclly. <br />(Bianaiwa of dr pcfsowMl nccMns appleaBon) <br />Ptfw <br />On bahaVorttwooun^, I acfcncMvIedgBMsappIcaliofv <br />Chock Iha aeflon tfMt <br />fho county la takbig on Vila appBeadon. <br />PI The county appiowa tin appfcaBoniMft no <br />U Mdfeig pcviod. <br />penntallwSOdaya. <br />Q The Gouiily denies the appicabon. <br />PrMmniaofewinhf. <br />nw. <br />Otto. <br />TQWNSHn^ OnbahddtwtiMNn»R».ladnoiiMgotMft <br />RuOMily to ipprowt or Oeny m tpotcaaon pyam. <br />M0^13,tuad.2)4 <br />Pitol wme tf tottuli^» <br />(Slgntlure d towndp oflfcW acknoMMglig ippMton) <br />T»t _______________________________ <br />/ <br />Chi«r Exacutivo Oflicor'a Signaturo <br />The inibnnalton providad In thb appicalion is complete and aocurata to Vie best of my knofwiadaoi <br />CMaf CBtocuOwt offload dsnatuia.r,__If TR?lik <br />Matw^ptoaaftPftoft ^^T^gL.cVx’Afi-.. Ick.t Date I If / D> <br />Mall Appllenlion nnd Attachmanta <br />At ieaat 46 days prior to your schedulad acttvty date send: <br />• Vw compi^ appicalion, <br />• a copy of your proof of nonpradl status, and <br />. n $25 «pdeaVonfBo(md(o check payabtolo "State of Mlnnaaota7 <br />Appicalion fees are not preratad. refundable, or tranifMMe. <br />Send to:1711 Want County Road B, tulle 300 South <br />Roaavlla. MN 66113 <br />....................................I. ....................................................