2. 
   
4. Filing fee is: $15.00 PER REQUEST,
   one form per parcel.
   Please make check payable to:
   Crow Wing County Land Services
6. 
   
8. I hereby file in accordance with Minnesota Statute 276.041, for the purpose of receiving notices of delinquent taxes, the following information:
10. 
    
12. Person requesting duplicate statement:*
14. Address of where statement is to be mailed:*
16. City:*
18. State*
20. Zip Code*
22. Name of taxpayer on parcel:*
24. Real Estate Tax Parcel Number (PID #):*
26. Legal Description:
28. Print this form, sign in the box at right, and mail with your check to:
    
    Crow Wing County Land Services
    322 Laurel Street, Suite 15
    Brainerd, MN 56401
30. 
    
32. THIS REQUEST SHALL EXPIRE THREE YEARS FROM THE DATE OF FILING.
34. 
    
Leave This Blank:


35. Print Only

* indicates a required field