Form Pt-48-5-7.7 - Forest Land Protection Assessment Applications

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PT-48-5-7.7 (Aug 2011)

FOREST LAND CONSERVATION USE ASSESSMENT COVENANT

Section A: Application

To the Board of Tax Assessors of ________________________County: In accordance with the provisions of O.C.G.A. § 48-5-7.7, I submit this application and the

completed questionnaire on the back of this application for consideration of Forest Land Conservation Use value assessment on the property described herein.

OWNERSHIP INFORMATION

Name of owner(s):

Owner’s mailing address

City, State, Zip

PROPERTY IDENTIFICATION

Property physical location

Total number of acres included in

this application:

County Parcel ID #

District

Land Lot

Deed Book/Page

Plat Book/Page

Acres

AUTHORIZED SIGNATURE

I, the undersigned, do hereby solemnly swear, covenant and agree that all the information contained above, as well as the information provided on the questionnaire, is true

and correct to the best of my knowledge and that the above described property qualifies under the ownership and land use provisions of O.C.G.A. § 48-5-7.7. I further swear

that I am authorized to sign this application on behalf of the owner(s) making application. I am aware that certain penalty provisions are applicable if this covenant is

breached pursuant to O.C.G.A. § 16-10-20.

_______________________________________________________________

___________________________________

Signature of Owner or Owner’s Authorized Representative

Date Application Filed

_______________________________________________________________

Signature of Owner or Owner’s Authorized Representative

*Additional owners may sign on back of form

Sworn to and subscribed before me this ________ day of _________________,

_____________________________________________

Notary Public

FOR TAX ASSESSORS USE ONLY

Covenant:

Begins: Jan. 1 _______

Ends: Dec. 31 _______

Covenant # ____________ _________________ ______________________

(Year)

(County Code)

(Covenant #)

Based on the information submitted and provided on the questionnaire, the ___________________________ County Board of Tax Assessors has considered such

information and has made the following final determination of this application:

Approved: ____ Date: _________

_________________________________________________________

_______________

Board of Tax Assessors

Date

Denied:

____ Date: _________ If denied, O.C.G.A. § 48-5-7.7 provides that the County Board of Tax Assessors shall issue a notice to the owner(s) in the same manner

as all other notices are issued pursuant to O.C.G.A. § 48-5-306 which can be appealed pursuant to O.C.G.A. § 48-5-311.

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