I hereby certify, pursuant to Section 76-3-611(1)(b), M.C.A., that no real property taxes and special assessments assessed and levied on the land described below and encompassed by the proposed _______________ (Name of Subdivision) are delinquent:

_________________________

_________________________

(legal description of land)

Dated this _____ day of __________, 19_____.

_________________________

(Signature of County Treasurer)

(seal)

Treasurer

_______________ County,Montana