2018-NOT RENTAL FORM Return form to:
CITY OF FRIDLEY
PLANNING DIVISION, ATTN: ZONING
Community Development Department
Fri<tley 6431 University Avenue, N.E. Fridley, MN 55432
Office(763) 572-3599 Fax (763) 502-4982
My single-family home located at 7dOLQ L K��" k1+;'�_ r_ is not being used as a two
family dwelling based on the following reason(s):
(Please initial and date each that apply)
/'� There is not a lockable door separating living spaces in the home.
The tenants have moved out or are moving out on
The home is"Family Occupied"; I do not live in the home but other
family members occupy the property (son, daughter, parent).
(Family member/relationship : )
The boarder(s) living in the home with me are not family members
but share the common living areas of the home with me.
Other, pl e exIain:, 1`
e r
THI /INFORMATION IS CORRECT AND TRUE AS OF THE DATE SIGNED
Owner 1 Owner 2
Print Name Print Name
J//4�
Owner 1 Owner 2
Si a ure Signature
STATE OF MINNESOTA )
) SS.
COUNTY OF- a )
On this ri day of� /12 20_&, before me a Notary Public within
and for said County, personally appeared to me, who being by me duly sworn and
acknowledged said instrument to be the free act and deed of the entity.
"`0+ dUUANNE M BEBERG
NOTARY PUBLIC
MINNESOTA
:. Iy onExpw.Jan.31,20W N Public