EXAMINER OF TITLES	COUNTY OF HENNEPIN

CPT FILE No.  	

In the Matter of the Application of

a  	

To Register Possessory Title to Certain Land

APPLICATION 
for Certificate of Possessory Title

STATE OF MINNESOTA        )
) ss COUNTY OF HENNEPIN	)

The undersigned, on behalf of the Applicant, hereby applies to register the possessory title to the land described in this Application pursuant to Minnesota Statutes, Chapter 508A and solemnly swears that the contents and statements made in this Application are true to the best of the undersigned’s knowledge, except as to those matters stated on the undersigned’s information and belief, and as to those matters the undersigned believes them to be true.

A.	Name of Entity: 	                                                                                                                             Principal Place of Business: 	

County of 	, State of  	

B.	Organized under the laws of  	

C.	Description of land: 

D.	Estate or interest claimed in the land is fee simple.

E.	The land is unoccupied [or]

The land is occupied as follows: [State the full name and address of each party and the nature of the estate, interest, lien, or charge which the party or parties have, or claim to have, in the land]

F.	The following persons or parties have or claim some right, title, estate, lien or interest in the land: [State the names of the persons or parties who appear of record or are known to the applicant and the nature and character of the claims.]

G.	The land is subject to the following liens or encumbrances: [State the character and amount of each lien or encumbrance, the name and post office address of the holder, and the recording information.]
A.	
H.	Applicant is in actual or constructive possession of the land.
Applicant requests the registration of a possessory estate in the land under a CPT.

Name of Entity

Signature

Title

Notary Seal

Subscribed and sworn to before me on

 	   by  	
date

Notary Public

Attorney for Applicant:
Name: 		Approved for Filing: Address: 	
Telephone:			 Fax: 		Deputy Examiner of Titles
Attorney Registration No.: 	                                     Email: