Park
Will the park be available to and accessible by the public? Yes No
Will there be signage indicating to the public this is a park? Yes No
Will the park contain amenities maintained for active
utilization by the public? Yes No
Type of amenities:
Will the park primarily be open space? Yes No
Public service facilities
Type of facility:
CONDITIONAL USE DEED SUPPLEMENT
Forfeiture
Date of recording of auditor’s certicate of forfeiture with the county recorder (if applicable) Recorder’s Document number (if applicable)
Date of recording of auditor’s certicate of forfeiture with the county registrar of titles (if applicable) Registrar’s Document number (if applicable)
Supplemental Information for a Conditional Use Deed
In ____________________________________ County
ALL applications (State Deed Application Form) for a conditional use deed must be accompanied by
a completed Conditional Use Deed Supplement form.
Property
Property identication number(s) (PIN) for requested property (attach additional sheets if necessary)
Market value of requested property Total acreage of requested property
Describe current condition of the parcel (identify any improvements and natural features)
Office Use only
This application it is hereby: rejected granted Fee Paid:
Refund:
By
Commissioner of Revenue
Rev. (12/18
)
Describe in detail the intended public use of the property:
Do you anticipate establishing the proposed use within 3-years? Yes No
If “no”, when do you anticipate the use being established?
Road or right-of-way for a road
Trails
Transit facilities
Public beach or boat launch
Public parking
Civic recreation or conference facilities
Authorized Public Use (Check only one box)
Minnesota Statute § 282.01, subd, 1a, par. (e) limits the authorized public uses for conditional use deeds to the following list.
Please check the appropriate box below:
Public Use
Fee Required
Minnesota Statute § 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.
Supporting Documentation
Indicate the supporting documentation that you have included for consideration during the review of your application.
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:
Enclosures
