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MINNESOTA• REVENUE CONDITIONAL USE DEED SUPPLEMENT Supplemental Information for a Conditional Use Deed ALL applications (State Deed Application Form)for a conditional use deed must be accompanied by a completed Conditional Use Deed Supplement form. Property identification number(s)(PIN)for requested property(attach additional sheets if necessary) - 32-30-23-12-0016 aTvfrfcei value of requested property Total acreage of requested pnxpr,rty 400 124sgft a Describe current condition of the parcel(identify any improvements and natural features) small triangular-shaped parcel with a stop sign posted on it-grass is cut on a regular basis. Date of recording of auditor's certtiiflcata o forfeiture with the county recorder(if applicable) Recorder's Document number(if applicable) Date of recording of auditor's certificate of forfeiture wit'�i the county registrar of titles(if applicable) Registrar's Document number(if applicable) gi August 9,2011 2148662 Authorized Public Use M.S.282.01,subd,la,par.(e)limits the authorized public uses for conditional use deeds to the following list. Please check the appropriate box below: ❑x Road or right-of-way for a road ❑ Park Will the park be available to and accessible by the public? 0 Yes 0 No ❑ Trails Will there be signage indicating to the public this is a park? 0 Yes 0 No ❑ Transit facilities Will the park contain amenities maintained for active utilization by the public? 0 Yes 0 No ❑ Public beach or boat launch Type of amenities: ❑ Public parking Will the park primarily be open space? 0 Yes 0 No z • ❑ Civic recreation or conference facilities ❑ Public service facilities Type of facility:_ a Describe in detail the intended public use of the property: ThP City of New Brighton plans to use this land for right of way purposes . Do you anticipate establishing the proposed use within 3-years? E Yes ❑ No If"no",when do you anticipate the use being established? -- Fee Required Minn.Stat.§282.01,subd.1g requires a fee of$250 to be submitted to the Commissioner of Revenue along with this application. If this application is denied,the Commissioner shall refund$150 of the application fee. ❑ The required fee is enclosed. g• Supporting Documentation Indicate the supporting documentation that you have included for consideration during the review of your application. W Please note that some forms of documentation are required. Check all that apply: ❑ Photos(required) ❑ Resolution authorizing application by the governmental subdivision(required) ❑ Maps(required) ❑ Plans documenting the intended use ❑ Other:_ - Office Use only T (This application it is hereby: rejected— granted Fee Paid: Refund: -- By Commissioner of Revenue 1 J Rev.(07/10)