When a property owner dies who was a recipient of medical assistance, a Certificate of Clearance could be needed to sell the property. This document shows whether they have a valid medical assistance claim against their property.
Certificate of Clearance forms
Consult a legal advisor to determine what forms you need.
Decree of Descent
Complete both of the following forms:
- Application for a Decree of Descent Medical Assistance Clearance Certificate (
DHS-6165A) - Medical Assistance Clearance Certificate for a Decree of Descent (DHS-6165B)
For DHS-6165A, make sure the form is complete.
For DHS-6165B, a partially completed form is acceptable. Make sure to include decedent's date of birth, date of death, and your “drafted by" information.
Transfer on Death Deed
Complete both of the following forms:
- Application for a Medical Assistance Clearance Certificate (DHS-5893)
- Medical Assistance Clearance Certificate for a Transfer on Death Deed (DHS-5893A)
For DHS-5893, make sure the form is complete.
For DHS-5893A, a partially completed form is acceptable. Make sure to include the legal description of the property, the decedent's date of birth, date of death and your “drafted by" information.
General
There is only one form to complete:
- Medical Assistance Clearance Certificate (DHS-5893B)
For DHS-5893B, a partially completed form is acceptable. Make sure to include the legal description of the property, the decedent's date of birth, date of death and your “drafted by" information.
Submitting applications
To get a Certificate of Clearance, please do the following:
- Make sure that the complete name, date of birth, date of death and social security number are included for the deceased individual.
- If there are any predeceased spouses, please provide their complete name, date of birth, date of death and social security number on the application, and their name, date of birth, and date of death on the certificate.
Failure to provide complete information, delays our ability to complete the form and send it back to you.
Please email completed forms to certificatesofclearance@co.dakota.mn.us.
Application processing
- Applications are processed in the order they are received.
- The county will mail the completed Certificate of Clearance within 15 working days.
- We will not process certificates until all required information is received.
If you have additional questions, please email certificatesofclearance@co.dakota.mn.us or call 651-554-6555.