Form Pt-283e - Application And Questionnaire For Current Use Assessment Of Environmentally Sensitive Property Page 2
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2CURRENT USE ASSESSMENT QUESTIONNAIRE – PT283E
ALL APPLICANTS, other than single titled owners, must list below each individual’s name that owns a beneficial interest in the property
described in this application, the percentage interest of each, the relationship of each (if the applicant is a family farm entity), and all other
information applicable to this application.
Percent
Counties where you own
Each Individual’s Name
interest for
interest in property under
Each owner’s percent interest
having any beneficial interest in the property
each owner
other covenants and total
owned and number of acres
described in this application
of property
acres included in each
owned by each under other
in this
covenant
covenants
application
Total
Percent
Number of
County
Acres
Interest
Acres
Check Appropriate Ownership Type:
[ ] One or more natural or naturalized citizens.
[ ] An estate of which the devisees or heirs are one or more natural or naturalized citizens.
[ ] A trust of which the beneficiaries are one or more natural or naturalized citizens.
[ ] A family owned farm entity (e.g., a family corporation, family partnership, family general partnership, family limited partnership, family
limited corporation or family limited liability company. Percent (%) of gross income from bona fide conservation uses. ______(including
earnings on investments directly related to past or future bona fide conservation uses, within this state within the year immediately
preceding the year in which eligibility is sought (include supporting tax records); provided, however, that in the case of a newly formed
family farm entity, an estimate of the income of such entity may be used to determine its eligibility (include supporting estimate records.)
[ ] Nonprofit conservation organization designated as a 501(c)(3) organization under the Internal Revenue Code. (Provide copy of IRS
determination letter/charter with application.)
[ ] Bona fide club organized for pleasure, recreation, and other nonprofitable purposes pursuant to Section 501(c)(7) of the Internal Revenue
Code. (Provide copy of IRS determination letter/charter with application.)
Check All Bona fide uses that apply and the percentage use, as they relate to the property described in this application.
[ ] Significant groundwater recharge area identified on maps or data compiled by the Department of Natural Resources %______
[ ] Habitats for endangered or threatened species certified by the Department of Natural Resources %______
[ ] Mountainous Terrain %______
[ ] Undeveloped Barrier Islands %_____
[ ] Wetlands as determined by the US Army Corps of Engineers, or depicted or delineated on maps compiled by the Department of Natural
Resources of the US Fish & Wildlife Service %______
[ ] River Corridors adjacent to rivers & perennial streams within the 100 year flood plain developed by FEMA or those buffer zones established
by law or local ordinance %______
1. Is this property or any portion thereof, currently being leased? (If yes, list the name of the person or entity and briefly explain how the
property is being used by the lessee, as well as the percentage of the property leased.)
The board of tax assessors may not approve an application without the following document:
Certification from the Department of Natural Resources pursuant to O.C.G.A. § 48-5-7.4(a)(2) that the property meets the criteria for current
use assessment of environmentally sensitive property.
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