Form Pt-283e - Application And Questionnaire For Current Use Assessment Of Environmentally Sensitive Property

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APPLICATION AND QUESTIONNAIRE FOR CURRENT USE

PT-283E Rev. 8/07

ASSESSMENT OF ENVIRONMENTALLY SENSITIVE PROPERTY

To the Board of Tax Assessors of ____________________County: In accordance with the provisions of O.C.G.A. § 48-5-7.4, I submit this application and the completed

questionnaire on the back of this application for consideration of current use assessment on the property described herein. Along with this application, I am submitting the

fee of the Clerk of Superior Court for recording such application if approved.

Name of owner (individual(s), family owned farm entity, trust, estate, non-profit conservation organization or club)

Owner’s mailing address

City, State, Zip

Number of acres included

in this application.

Property location (Street, Route, Hwy, etc.)

City, State, Zip

District

Land Lot

Sublot & Block

Recorded Deed Book/Page

Has property been certified by the Department of Natural Resources as environmentally

sensitive? [ ] No [ ] Yes, attach certification

AUTHORIZED SIGNATURE

I, the undersigned, do hereby solemnly swear, covenant and agree that all the information contained above, as well as the information provided on the questionnaire, is true

and correct to the best of my knowledge and that the above described property qualifies under the ownership and land use provisions of O.C.G.A. § 48-5-7.4. I further swear

that I am authorized to sign this application on behalf of the owner(s) making application that that no individual associated with the ownership of this property has any

beneficial interest in more than 2,000 acres in this or any other conservation use property in Georgia, and that certain penalty provisions are applicable if this covenant is

breached.

_________________________________________________

_____________

Sworn to and subscribed before me this _____ day of _______________, _______

Signature of Taxpayer or Taxpayer’s Authorized Representative

Date Filed

_________________________________________ Notary Public

If denied, Georgia law O.C.G.A. § 48-5-7.4 provides that the applicant may appeal in the same manner as other property appeals are made pursuant to O.C.G.A. § 48-5-311.

TAX ASSESSOR USE ONLY

FOR TAX ASSESSORS USE ONLY

Map and Parcel Number

Tax District

Taxpayer Account Number

Yr Covenant:

Begins: Jan 1 _______

Ends: Dec 31 _______

If initial application, date transferred from Preferential

If applicable, covenant is a renewal for tax year :

If applicable, covenant is a continuation for tax year

Agricultural Assessment: ___________________

Beginning Jan 1, _______ Ending: Dec 31, _______

Based on the information submitted above, as well as the information provided on the questionnaire, the _______________ County Board of Tax Assessors has considered

such information and has made the following final determination of this application:

Approved: ____ Date: _________

_______________________________________

___________________

Board of Tax Assessors

Date

Denied:

____ Date: _________

If denied, the County Board of Tax Assessors shall issue a notice to the taxpayer in the same manner as all other notices are issued pursuant to O.C.G.A. § 48-5-306.

APPLICATION FOR RELEASE OF CURRENT USE ASSESSMENT OF ENVIRONMENTALLY SENSITIVE PROPERTY

I, the owner of the above described property, having satisfied all applicable taxes and penalties associated with the covenant above; do hereby file this application for release

of current use assessment with the county board of tax assessors. Pursuant to O.C.G.A. § 48-5-7.4(w), no fee is required for the clerk of superior court to file and index this

release in the real property records of the clerk’s office.

Sworn to and subscribed before me

_____________________________

_______________________________

This ___ day of _________, ______

Taxpayer’s Authorized Signature

Approved by: Board of Tax Assessors

_____________________________

______________________________

________________________________

Notary Public

Date Filed