Form Rp-305-R - Agricultural Assessment Renewal Application Page 3
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3RP-305-r (2/12)
Page 3
Certification of Applicant
I, _______________________________________ certify that the information entered on this application constitutes a
true statement of facts to the best of my knowledge and that all lands described are used for the purposes stated herein.
I have read the notice page explaining the consequences for converting land to a nonagricultural use and understand
that conversion of this parcel may subject it to payments based upon the amount of taxes saved.
Date _________________________
Signature of Owner _______________________________________
Penalty for false statements: A person making false statements on an application for exemption is guilty of an offense
punishable by law.
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