Form Cr-Sah - Application For Special Agricultural Homestead
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2For Office Use Only
Approved
Name of applicant ________________________________Assessment year ____________
CR-SAH
Denied
Assessor’s signature ______________________________Date _______________________
Application for Special Agricultural Homestead
_______________ County
Homestead on Non-Contiguous Farmland - Minnesota Statutes 273.124, Subdivision 14, Paragraph (b)
Some of the information contained on this application is private data. Minnesota Statutes 273.124, subdivision 13 authorizes the collection of Social Security
Numbers for use on homestead applications. Other information collected on this form is necessary to verify eligibility for the Special Agricultural Homestead
provision. Some or all of the information contained on this form may be shared with the County Assessor, the County Attorney, the Commissioner of Revenue,
and other federal, state, or local taxing authorities for the purpose of verifying your eligibility for this program or your other tax obligations. You can refuse to
provide the information on this form. However, such refusal will cause you to be disqualified from this program.
Last Name of Farmer
First Name of Farmer
M.I.
Social Security Number
Mailing Address - Street
City/Town
State
Zip Code
County of Residence
City/Town of Residence
Daytime Phone
Evening Phone
Please answer the following questions and attach the requested forms.
YES NO
1. I am either the owner/ spouse of the owner; or child, grandchild, parent, or sibling of the owner/spouse of owner.
2. I am actively farming the agricultural property listed.
a. I participate in the day-to-day labor and decision making on the farm.
b. I contribute administration and management to the farming operation.
c. I assume all or a portion of the financial risks and participate in any profits or losses.
3. I am a Minnesota resident.
4. I live within four townships or cities from the agricultural property listed.
5. I filed a Schedule F or Federal Form 1065 for partnerships, Federal Form 1120 for corporations or
Federal Form 1120S for S corporations with my federal income tax return for the most recent tax year.
6. The Farm Service Agency (FSA) lists me as an operator.
My FSA number is ___________________________________________ in __________________________________________County.
My FSA number is ___________________________________________ in __________________________________________County.
By signing below, I certify that the above information is correct.
Signature of Farmer
Date
Last Name of Owner
First Name of Owner
M.I.
Social Security Number
Last Name of Spouse
First Name of Spouse
M.I.
Social Security Number of Spouse
Mailing Address - Street
City/Town
State
Zip Code
County of Residence
City/Town of Residence
Daytime Phone
Evening Phone
Continued on next page.
(Rev. 5/13)
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