e-Permitting - Cook County, Minnesota

Emergency Management Physical Address Replacement Application UID # 10339
App. Status: ApprovedMike Keyport
218-387-3059
mike.keyport@co.cook.mn.us

Property Owner Information:

Name:

Mark Allen DuChene

Phone:

(612

) 245

- 8896

Email Address:

mark.dchn@gmail.com

Mailing Address:

Property Information:

Parcel and Address				Section Township Range				Lake	Owner Information	Tax Payer Information
Parcel Number	Property Address	City	Deeded Acres	Township Number	Township or City	Section	Range	Lake Name	Owner Name	Taxpayer Name
25-227-2150	392 PANCORE LK RD	TOFTE MN	20.01	61	TOFTE TWP	27	4	PANCORE	DUCHENE MA-BUNDE MK	DUCHENE MA-BUNDE MK

Terms and Conditions

I hereby certify with my signature that all data on my application forms, plans, are true and correct to the best of my knowledge

Charge	Cost	Quantity	Total
Non-Taxable
Physicsl Address Replacement Application Fees added 10/17/2024 9:15 AM $25.00	$25.00	x 1	$25.00
Subtotal			$25.00 0
Grand Total
Total			$25.00
Payment 10/17/2024			$25.00
Due			$0.00

Approval	Signature
Applicant	Mark A. DuChene - 10/17/2024 9:15 AM 119c79b5b2667dd4eb65058975f2723a 8b20eac70b3d8e55a6f0a394059f6048
#3 Sign Made	Mike Keyport - 10/17/2024 9:21 AM d13943be1156afef3a5f609ff7bdf655 4c228fa0d317ba191b0b736c72f2f926

Application has been approved. All signatures have been obtained.