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Application to Repurchase after Forfeiture Pin: 18-30-23-11-0002 Legal Description: Iron Works Plat First Addiiton, Lots 5 thru 10, Block 2 Address: North of 2550 Long Lake Road (0 Long Lake Road) Forfeiture Date: Aucust 1, 2012 I hereby make application to repurchase the above described parcel of land, located in Ramsey County,from the State of Minnesota,and understand that pursuant to Minnesota Statutes,section 282.241: • The owner at the time of forfeiture,or the owner's heirs,devisees, or representatives,or any person to whom the right to pay taxes was given by statute, mortgage,or other agreement, may file an application to repurchase any parcel of land claimed by the state to be forfeited to the state for unpaid property taxes, unless sold or conveyed to a third party. • The property may be repurchased for the sum of all: o Cancelled taxes, including all delinquent real property taxes, plus penalties, accrued interest and costs attributable to the taxes, o All property taxes plus penalties, interest and costs on those taxes for the taxes payable year following the year of the forfeiture and all subsequent years through the year of repurchase. o All delinquent special assessments cancelled at the time of forfeiture, plus penalties,accrued interest and costs attributable to those assessments. o Special assessments not levied between the date of forfeiture and the date of repurchase. o Any additional costs and interest relating to taxes or assessments accrued between the date of forfeiture and the date of repurchase. o Extra costs related to repurchase and recording.of deed. • A$250.00 administrative service (repurchase)fee, in certified funds, Is due at the time the application is submitted. • All maintenance costs accrued on the property while under the management of Ramsey County,Tax Forfeited Land,from the date of forfeiture until the adoption of a resolution by the Ramsey County Board of Commissioners,are to be paid by the applicant. • Applicant will take possession of the property and be responsible for its maintenance and security upon approval of the repurchase by the Ramsey County Board of Commissioners. The reason or circumstances that led to the forfeiture of the property is (describe hardship): See attached Exhibit A. Return application to: Department of Property Records and Revenue,Attn:Tax Forfeited Lands Section, PO Box 64097,St. Paul, MN 55164-0097