Le Sueur County, Minnesota

Forms

Recorder's Office Forms:

Birth Certificate Application
Death Certificate Application

Assessor's Office Forms:

Owner Occupied Homestead Form	Relative Occupied Homestead Form
Disabled Veteran (100%) Exclusion form	Disabled Veteran (70% or more) Exclusion form
Blind or Disabled Special Homestead form	Green Acres Form

Day Care Provider Forms:

Admission and Arrangement Form	2006 Legislative Changes
Immunization Record	Day Care Rule Summary for Parents
Emergency Medical Care Authorization	DayCare Liability
LIABILITY INSURANCE COVERAGE	GENERAL TRAVEL
Over the Counter Permission	Updated Variance Request
Prescription Med Permission	Wading pool consent
Variance instuctions	Do I really need insurance?
Home Safety Checklist	Injury Report Form
Wading pool letter	Capacity Variance Procedures

Environmental Service Forms:

Variance Application	Septic Disclosure Form
Monitoring Record Form	Le Sueur County ISTS Site Evaluation Form
"Other" System Monitoring Form	"Other Establishment" Monitoring Form
Pumping Contract Form	Pumping Disposal Worksheet

Highway Department Forms:
Moving Permit
Driveway Entrance Permit

Human Services Forms:

Letter to Medical Assistance Recipients	Notice of Access-What You Get Paid For
Sample of How to Complete Claim Forms	Documentation of Medical Appointment
Meal Reimbursement Explainations	Blank Claim Forms for Clients to Use

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