Applicant is: County auditor
Property owner Owner’s agent
Applicant Information
Name(s) of applicant(s)
Mailing address of applicant
City State Zip code Phone
Application for Cancellation of Forfeiture
in County
The applicant requests that the certificate of forfeiture for the property described below be canceled pursuant to
Minnesota Statutes, sections 279.33 and 279.34.
(10/19)
Certicate of
Forfeiture
Signature of county auditor County Date Phone
Sign
Here
Date of execution Date of recording
Location of recording Recording number
Property
Information
Legal description of property: (attach additional sheets if needed)
Cancellation
PT90
Certicate of Forfeiture
Reason for Cancellation
Exemption
Administrative error
Explain in detail the reason(s) for cancellation. Attach additional sheets if necessary.
County
Approval
Auditor to complete this section.
The County Board and county auditor of County, Minnesota, have reviewed this application for the
cancellation of the certicate of forfeiture for the property described above, pursuant to Minnesota Statutes 279.33 and 279.34, and
recommend that the cancellation be granted by the Minnesota Department of Revenue.
Department Use Only
Commissioner of Revenue By Date application received by Minnesota Department of Revenue
Minnesota Department of Revenue’s number County Auditor’s number
Return application to: Minnesota Department of Revenue Property Tax Division Mail Station 3340 St. Paul, MN 55146-3340
Order of the Minnesota Department of Revenue
Upon examination of the contents of this application, it is hereby:
rejected. Reasons for rejection:
accepted. The certicate of forfeiture is to be canceled, and the county auditor is to record this application as a certicate of cancellation
pursuant to Minn. Stat. 279.33 and 279.34 which will void the tax forfeiture of the property described in this application.
All or part of the described real property is registered (Torrens): Yes No
Signature of applicant Date
Sign
Here
