Schedule Au (Form Rev-1197) - Agricultural Use Exemptions

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REV-1197 (5-13)
SCHEDULE AU
AGRICULTURAL USE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
EXEMPTIONS
PO BOX 280601
HARRISBURG PA 17128-0601
Start
ESTATE OF:
FILE NUMBER:
Use this schedule to report real estate for which you claim an exemption from inheritance tax under the “Farmland - Other”
Exemption (72 P.S. § 9111(s.1)) or the “Business of Agriculture” Exemption (72 P.S. § 9111(s)). Check the box below next
to the exemption you are claiming (select only one):
®
®
Business of Agriculture Exemption
Farmland - Other Exemption
Complete Parts 1 and 2 of this form.
Agricultural
Conservation
Easement;
Agricultural
Reserve; Agricultural Commodity; Agricultural Use
Property; or Forest Reserve (Definitions on back of
form). Complete Part 1 and check the applicable
category on the back of this form.
Attach a written statement explaining in detail how the real estate qualifies for the claimed exemption. In addition, if you
are claiming an exemption for any structure affixed to the real estate, identify the structure and explain in detail how each
structure qualifies for the claimed exemption. Structures affixed to the real estate that do not qualify for an exemption must
be valued and reported on Schedule A to the Inheritance Tax Return. Please also attach all supporting documents with the
written statement, including the county assessment card. Failure to provide this information may result in a denial of the
claimed exemption or a delay in processing your return.
PART 1: PROPERTY INFORMATION
Property Parcel Identification Number:
Percentage of Parcel Exempted:
Date of Death value under 72 P.S. § 9121:
Physical Location:
STREET ADDRESS (DO NOT REPORT P.O. BOX)
CITY
COUNTY
PART 2: OWNER(S)’S INFORMATION
Provide the name and mailing address of all transferees of the real estate listed above (attach additional sheets if necessary):
OWNER NAME
RELATIONSHIP TO DECEDENT
OWNER NAME
RELATIONSHIP TO DECEDENT
MAILING ADDRESS
MAILING ADDRESS
CITY
STATE
ZIP
CITY
STATE
ZIP
OWNER NAME
RELATIONSHIP TO DECEDENT
OWNER NAME
RELATIONSHIP TO DECEDENT
MAILING ADDRESS
MAILING ADDRESS
CITY
STATE
ZIP
CITY
STATE
ZIP
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