APPLICATION FOR TAX ABATEMENT UNDER THE

			 CITY OF LAKE MILLS REVITALIZATION PLAN



				  CITY OF LAKE MILLS

				WINNEBAGO COUNTY, IOWA









Owner of Record:_______________________________________________________________



Property Address:____________________________________Lake Mills, Iowa 50450



						Telephone:_____________________



Legal Description of said property:____________________________________________



_______________________________________________________________________________





Address of Owner (if different than above):____________________________________



Existing Property Use:______Residential______Commercial______Vacant______Other



Proposed Property Use:



Nature of Improvements:____New Construction____Addition____General Improvements



	Describe Improvements:_________________________________________________



_______________________________________________________________________________



_______________________________________________________________________________



Actual Date of Completion:__________________________,20____



Actual Cost of Improvements: $_____________________________



Tax exemption schedule is attached.



Executed this_______day of_____________________________,20 ______







					_______________________________________

					Applicant / Owner of Record