Special Assessments: Checklist and Sample Forms

The checklist and sample forms on this page help cities complete the steps in making a special assessment for a local improvement under Chapter 429 of the Minnesota Statutes.

Before using these forms:

  • Read the Special Assessment Guide (pdf) to understand the procedure and areas for special care.
  • Be aware that the League of Minnesota Cities provides the Special Assessment Guide and sample forms as informational material on a detailed statutory procedure.
  • Consult your attorney, engineer, qualified licensed appraiser and financial advisor for professional advice in using these materials.

How to use these forms:

  • All forms are Microsoft Word documents; open a document and save it to your computer using the "Save As" command under "Page" in Internet Explorer 9 or under "File" in Word.
  • Read all footnotes to assist you in best completing the forms.
  • Remove all footnotes before making any official use of the forms (i.e., adoption, publication, notice) by selecting (highlighting) and deleting each superscript number in the form. The corresponding footnote text will be removed at the same time.


I. Special Assessment Procedure Checklist

II. Complete Set of Forms for Special Assessments

III. Individual Forms for Special Assessments Forms for Commencing Improvements (Forms 1 - 8)
1. Petition for Local Improvement (100 percent of property owners)
2. Agreement of Assessment and Waiver of Irregularity and Appeal
3. Petition for Local Improvement (at least 35 percent of property owners)
4. Resolution Declaring Adequacy of Petition and Ordering Preparation of Report
4A. Alternate Resolution Ordering Preparation of Report
5. Resolution Receiving Feasibility Report and Calling Hearing on Improvement
6. Notice of Hearing on Improvement
7. Resolution Ordering Improvement and Preparation of Plans
7A. Alternate Resolution Ordering Improvement and Preparation of Plans
8. Resolution Ordering Installation of Service Laterals for Sewer and Water in Advance of Street Paving

Forms for Plan Approval and Advertisement for Bids (Forms 9 - 11)
9. Resolution Approving Plans and Specifications, and Ordering Advertisement for Bids
10. Advertisement for Bids
11. Proposal for Local Improvement

Forms for Assessing Cost (Forms 12 - 19A)
12. Resolution Declaring Cost to be Assessed, and Ordering Preparation of Proposed Assessment
13. The Assessment Roll
14. Resolution for Hearing on Proposed Assessment
15. Notice of Hearing on Proposed Assessment
15A. Affidavit of Mailing Assessment Hearing Notice
16. Resolution Adopting Assessment
17. Appeals to District Court
17A. Notice of Final Assessment
18. Certificate to County Auditor
18A. Alternate Certificate to County Auditor (for annual certification plan)
19. Notice of Assessment Against Public Corporation
19A. Certificate to County Recorder of Deferred Assessments

Forms for Contracting and Work Under Contract (Forms 20 - 26)
20. Resolution Accepting Bid
21. Contract
22A&B. Contractor's Performance and Payment Bonds
23. Engineer’s Estimate for Partial Payment
24. Order to Suspend Work
25. Engineer's Recommendation for Final Acceptance
26. Resolution Accepting Work

Forms for Work by Day Labor (Forms 27 - 28)
27. Resolution Approving Plans and Specifications, and Ordering Work Done by Day Labor
27A. Resolution Ordering Improvement by Day Labor
28. Detailed Report on Construction Work by Day Labor

Special Forms for Street Graveling, Grading, and Bituminous Surfacing Done by Day Labor (Forms 29A - 29B)
29A. Resolution Making Estimates of Materials and Equipment, and Ordering Advertisement for Bids
29B. Advertisement for Bids