EXAMINER OF TITLES	COUNTY OF HENNEPIN	
CPT FILE No.                

In the Matter of the Application of		
		
	                       APPLICATION	

To Register Possessory Title to Certain Land	                          for Certificate of Possessory Title	
		
STATE OF MINNESOTA	    )		
                                                  )  ss		
COUNTY OF HENNEPIN         )		
		
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 of this Application are true to the best of Applicant’s own knowledge, except as to those matters stated on Applicant’s information and belief, and that as to those matters Applicant believes them to be true.

A.	Name:		
	Address:		
			
[Note: If Applicant is not a resident of the state of Minnesota, see Minn. Stat. §508A.07 regarding appointment of an agent.]

Applicant is 18 years of age or older and is not under any legal incapacity.

B.	Applicant is ____married to 																			

	who resides at 																					

	Applicant has never been divorced, except:  [State the date of the divorce decree, the county and state where granted, the court file number and the name of the former spouse;  if no divorce strike “except”]

C.	Description of land: 

	

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

E.		The land is occupied by Applicant  [or]  
	
	  The land is unoccupied     [or]

	  The land is occupied as follows: [State the full name and address of each occupant and the nature of the 	estate, interest, lien, or charge which the occupant or occupants 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. ]

H.	Applicant is in actual or constructive possession of the land.

Applicant requests registration of a possessory estate in the land under a CPT.

		
		Applicant's Signature
Subscribed and sworn to before me on 

		by 	
	date	

_________________________________________
                            applicant

	Notary Public

Notary Seal	

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