Examiner of Titles

CPT No.

I/We hereby apply to register the possessory title to the land described below pursuant to Minnesota Statutes Chapter 508A and solemnly swear that I/we know the contents of this Application are true of my/our own knowledge except as to those matters stated on information and belief, and that as to those matters I/we believe them to be true.

Cross out all paragraphs or words not applicable.

A.Name(s):and

Address(es):

I/We am/are 18 years of age or older.

OR

I/We am/are not 18 years of age.

List applicants who are not 18 years of age:

B.I/We am/are not married.

OR

is married to

who resides at and is married to who resides at

AND

is married to

who resides at

Cross out all paragraphs or words not applicable.

I/We have not been divorced.

OR

If an applicant has been divorced, please include the following information:

State where divorce was obtained:

County where divorce was obtained:

Court File No.

Date of Decree

I/We am/are not under any legal incapacity except for:

If none, state "None".

C. Description of land (if description is lengthy, you may attach an exhibit):

D. The estimated market value of the land to be registered, exclusive of buildings and/or improvements, according to the last official assessment is $ .

E. Estate or interest claimed in the land is fee simple and is subject to homestead.

OR

Estate or interest claimed in the land is fee simple and is not subject to homestead.

F. The names and addresses of all persons or parties, except the applicant, who appear of record, or who are known to the applicant to have or claim any right, title, estate, lien or interest in the abovedescribed land:

If, after due and diligent search, applicant cannot ascertain the address of one or more of the parties named above, address may be given as "Unknown".

G. The land is unoccupied.

OR

The land is occupied by the following parties:

H. There are the following liens and encumbrances on the land, recorded or unrecorded:

If, after due and diligent search, applicant cannot ascertain the address of one or more of the parties

named above, address may be given as "Unknown".

I/We hereby further state that I/we am/are the record owner(s) of the land and am/are in actual or constructive possession of it.

WHEREFORE, I/we request that the Examiner of Titles issue a report finding that I/we hold a possessory estate in the land herein described, as defined in Minnesota Statutes Section 508A.01, Subd. 3.

Signature(s) of Applicant(s)

Notary Public Notary Public