Form 201 Fp - Forest Products Harvest Tax Return Sample (2004) - Oregon Department Of Revenue Page 37

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For Assessor’s Use Only
APPLICATION FOR
Date Received
Approved
Denied
DESIGNATION OF LAND AS FORESTLAND
Date: _________ By: _________
Comments:
and for special assessment as provided by
ORS 321.358 to 321.367 in western Oregon
and ORS 321.805 to 321.825 in eastern Oregon
INSTRUCTIONS:
• Your application must be fi led with the county assessor’s offi ce by April 1.
• Additional requirements and general information are located on the back. Read and complete both sides of the form.
Filed with the ___________________________________County Assessor for the tax year beginning July 1, 20____.
Name
Telephone
(
)
(
)
Day:
Evening:
Street Address
City
State
ZIP Code
DESCRIPTION OF PROPERTY
Fill in the boxes below to show the property you want to have designated as forestland. If you are applying for only a portion of the land
described, please indicate the area by providing a sketch below.
Date Acquired
Assessor’s Account Num ber
Map and Tax Lot or Parcel Number
Acres Applied For
(see #8 on the back)
acres
Total Applied For:
DESCRIPTION OF LAND FOR DESIGNATION AS FORESTLAND
Sketch a diagram of the tax lot(s) and shade in the area being applied for designation as forestland. See the example shown below. Include
placement of structures, roads, creeks, etc.
Example
1700
1800
1900
House
DECLARATION
As owner of the above described land, I indicate by my signature that I am aware of the potential tax liability involved when the land ceases
to be designated as forestland. I declare under the penalties of false swearing (ORS 305.990(4)) that I have ex amined this ap plication
(and any ac companying doc uments), and to the best of my knowledge, it is true, cor rect, and com plete.
Date
Forestland Owner’s Signature
X
Additional requirements on the back ➔
150-309-024 (Rev. 10-03)
For more information, contact your county assessor’s offi ce.
37
150-441-409 (Rev. 2-05)

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