Get Clearance Certificate For

Filling out the Clearance Certificate for public or medical assistance claims can seem complex, but this guide simplifies the process. Follow the detailed instructions to ensure accurate completion of the form online.

Follow the steps to complete the Clearance Certificate effectively.

1. Click ‘Get Form’ button to obtain the Clearance Certificate form and open it in the editor.
2. Enter the date in the specified format (month/day/year) at the top of the form. This ensures the form is correctly time-stamped.
3. In the first section, provide the name of the county agency authorizing the Clearance Certificate. Ensure you accurately reference the agency as defined under applicable Minnesota statutes.
4. Next, input the location of the real property covered by this Clearance Certificate. Include the county and legal description of the property.
5. If applicable, indicate whether any part of the property is registered (Torrens) by checking the appropriate box.
6. In section 3, check the corresponding box to indicate whether there is a claim or lien in favor of the State of Minnesota or the county agency against the decedent. Fill in the required information for the decedent, including their full name, date of birth, date of death, and the amount of the claim.
7. In section 4, repeat the process for any predeceased spouse(s) of the decedent. Check the corresponding box and provide their information in the same format as section 3.
8. In section 5, check the appropriate box to state whether the Clearance Certificate is subject to any conditions or restrictions and attach any necessary documentation if applicable.
9. Provide the contact person’s name, phone number, and email address at the county agency for claims or liens mentioned in sections 3 and 4.
10. Complete the final section with the authorized signature from the county agency representative, ensuring their name and the name of the county agency are also included.
11. Lastly, if needed, indicate the notarial officer's information, including their signature, title, and commission expiration date. Be sure to have it stamped as necessary.
12. Once all sections of the form are completed, you can save your changes, download a copy for your records, print the form, or share it as required.

Start filling out your Clearance Certificate online today!