Application For Use Value Assessment And Taxation Of Agricultural, Horticultural Or Forest Lands Form - Randolph County Tax Department Page 2
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1
2SECTION B –
AGRICULTURE & HORTICULTURE USE
Indicate gross income from each crop that was sold, or had it been sold, for the past three years. If land is rented, you may
DO NOT INCLUDE RENT
need to contact farmer for
income.
NOTE:
; only income from crops, plants, or animals.
Year
# of Acres
Income
# of Acres
Income
# of Acres in
Income
Total
in Crops
in Livestock
Other Products
Income
*
2015
2014
2013
* Attach a copy of your most recent Schedule F (Form 1040) showing your reported farm income and expenses. *
Is this farm in an active CRP program?
YES
___
NO
___
Was the income listed above reported for NC income tax for the owner?
YES____ NO____
If ‘NO’, please explain or give
name of person reporting the income: ________________________________________________________________
If this tract is leased or rented, give the name and address of tenant: _______________________________________________
___________________________________________________________________________________________________
SECTION C
– FOREST LAND
Are you currently actively engaged in the commercial production of timber and forest products under a sound management
program to obtain the greatest net return from the land consistent with its conservation and long term improvement?
YES
_____ NO_____
To qualify for use value assessment this forestland must have a written management plan prepared by a certified forester and
the plan must be followed.
The forestland must be in compliance with a current written sound forest management plan
as of January 1, 2016.
-Attach a copy of your forest plan as part of this application-
Date of current Forestry Management Plan:
________________________________
I, THE UNDERSIGNED, CLEARLY UNDERSTAND THAT:
1.
I have applied to have my land taxed by Randolph County at Present-Use value and that the difference between the tax at
market value and the tax at present use value with interest will be deferred as long as the use of the property meets the
requirements of North Carolina law.
2.
If my property becomes ineligible for taxation at present use value that the current year and the three (3) prior years of
deferred taxes and interest will become due immediately.
3.
I am required by N.C. General Statute 105-277.5 to report to the tax department during the listing period, any changes that
occurred in the past year which could disqualify all or part of the land which is being taxed at present use value. Failure to
report changes may result in a penalty of ten percent (10%) of the total deferred taxes.
4.
State law requires the Tax Department to audit my application and the use of my farm to determine if the use continues to
be eligible for deferred taxes and that I will be asked for income and other information periodically as part of the audit process.
-----------------------------------------------------------------------------------------------------------------------------------------------------
AFFIRMATION (Must have signature of each owner –
use a blank page for additional
signatures)
I (we), the undersigned, declare under penalties of law that this application and any attachments hereto have been
examined by me (us) and to my (our) knowledge and belief, are true and correct.
______________ ________________
_________________________________________ Owner
YES___ NO ___
DATE
TELEPHONE
SIGNATURE
______________ ________________
_________________________________________ Owner
YES___ NO ___
DATE
TELEPHONE
SIGNATURE
______________
________________
_________________________________________ Owner
YES___ NO ___
DATE
TELEPHONE
SIGNATURE
______________
________________
_________________________________________ Owner
YES___ NO ___
DATE
TELEPHONE
SIGNATURE
*
Remember to attach your current forestry management plan and/or Schedule F, whichever
*
applies.
PUAPL2016
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