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Hennepin County Government Center <br />Department of Property Tax and Public Records <br />A-607 <br />Minneapolis, MN 55487 <br />ATTN: ID Controller <br />I hereby make request for a combined assessment and legal combination of the following described <br />land: <br />and <br />Orig. PID # <br />Orig. Address: <br />Legal description: <br />Orig. PID # <br />Orig. Address: <br />Legal description: <br />17-117-23-34-0012 <br />2389 Blaine Avenue <br />The East 132 feet of the South 295 feet of Lot 5 Block 9 <br />Townsite of Langdon Park, subject to roads <br />17-117-23-34-0047 <br />Unassigned <br />Outlot A Navarro <br />New Address: 2389 Blaine Avenue <br />Municipal Code: 38 Tax Year: 2010 <br />( l /l /09-12/31 /09 application period) <br />Signature of Fee Owner Signature of Taxpayer <br />Printed Name Printed Name <br />Tax Statements should be sent to: <br />Date Signed