Form Lu-Afcfb - Agricultural Land, Forest Land, Conservation Land And Farm Buildings Use Value Appraisal Application Form Page 3

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AGRICULTURAL LAND, FOREST LAND, CONSERVATION LAND AND FARM BUILDINGS USE VALUE APPRAISAL

APPLICATION FORM

Please check if:

New Enrollment

Addition to enrolled parcel

Please read instructions on cover page - DO NOT SEPARATE THIS FORM.

SECTION 1. To be completed by landowner (Please Print or Type - Provide all information and return all copies or this application will be returned.)

3. Applications must be postmarked or delivered by September 1

NAME OF LANDOWNER (list all persons holding record title to this parcel):

to: Property Valuation and Review, Current Use Program,

133 State Street, Montpelier, VT 05633-1401. Enclose 3

copies of the map and a check for $40.00 made payable to

Property Valuation and Review for the application fee.

LANDOWNER'S MAILING ADDRESS:

4. PROPERTY LOCATED IN TOWN OF (if located in more than one

town, file a separate application for each town):

PHONE:

5. LOCATION OF PROPERTY (example: north side of intersection of Town

Road #14):

SCHOOL PROPERTY

ACCOUNT NUMBER (SPAN):

ACCORDING TO YOUR TOWN'S GRAND LIST, HOW MANY TOTAL ACRES IN THIS PARCEL DO YOU OWN? _______________________ ACRES

FROM THE TOTAL ACRES IN QUESTION 7, HOW MANY ACRES ARE YOU EXCLUDING FROM USE VALUE APPRAISAL? _______________ ACRES

(At a minimum you must exclude: 2 acres of land surrounding each dwelling, house, or mobile home. See instructions for other exclusions.

EXCLUDED PORTIONS: (To prevent you from being charged a penalty in the future on excluded land, precisely describe each portion of land that is on Line 8.) _______

_______________________________________________________________________________________________________________________________________

10. ACRES TO BE APPRAISED AT USE VALUE:_______________

11. FARM BUILDINGS ACTIVELY USED BY A

FARMER:

<1 Mile

>1 Mile

<1 Mile

>1 Mile

Provide number of each type to be enrolled.

Active Agriculture

________

Conservation

________

Sugarhouse

___________

Open/Idle Ag (20% Rule Limit)

________

Nonprod Forest (>20% Rule)*

________

Greenhouse

___________

Farm Employee Housing

___________

Productive Forest I, II, III

________

Significant Wildlife Habitat*

________

Farm Crop Processing Facility

___________

Special Places/Sensitive Sites*

________

Nonprod Forest (20% Rule Limit) ________

________

Barn

___________

Ecologically Significant TA*

________

Miscellaneous/<1 Acre*

________

Shed

___________

Silo

___________

*Requires County Forester approval with forest management plan.

TOTAL

___________

12. ANSWER THE FOLLOWING QUESTIONS: Unanswered questions will limit eligibility

A. Is there acreage in the same ownership and contiguous to the total acres on Line 7 which is not included in this application?

Yes

Are there any dwellings, houses, mobile homes or other buildings on the entire property? . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

If YES, give number and type:___________________________________________________________________

C. Do you (owner) qualify as a farmer by making half of your gross income from the business of farming as defined in

Regulation 1.175.-3 of the Internal Revenue Code of 1986 and/or from the sale of processed products produced from

75 percent of the farm crops produced on the farm? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

D. Was the dwelling(s) on Line 11 in use during the preceding tax year exclusively to house one or more farm employees,

as defined in 9 V.S.A. §4469, and their families, as a nonmonetary benefit of the farm employment? . . . . . . . . . . . . . . . . . .

Yes

If you (owner) do not qualify as a farmer, are your farm buildings leased to and actively used by a qualifying farmer under

a written lease of at least 3 years? (Enclose copy of lease stating farm buildings being leased.) . . . . . . . . . . . . . . . . . . . . . . .

Yes

APPLYING FOR AGRICULTURAL LAND:

Is this application for at least 25 contiguous acres in active use for any of the following? Check all that apply. . . . . . .

Yes

Cropland ____

Hay land ____

Orchard ____

Sugarbush ____

Christmas trees ____

Pasture ____

Application for less than 25 contiguous acres:

Is the land contiguous with other land you own in the next town, making at least 25 acres? . . . . . . . . . . . . . . . . . .

Yes

Does the land produce gross income of at least $2,000/year from the sale of farm crops? . . . . . . . . . . . . . . . . . . . .

Yes

Is the land leased to and actively used by a farmer under a written lease for at least 3 years? . . . . . . . . . . . . . . . . .

Yes

(Enclose copy of lease stating actual property being leased.)

APPLYING FOR FOREST LAND:

Is your application for at least 25 contiguous acres of forest land? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

Is more than 20% of the land nonproductive forest land or open land (see instructions)? . . . . . . . . . . . . . . . . . . . . . . . .

Yes

If applying for less than 25 contiguous forested acres, is the land contiguous with land you own

in the next town, making at least 25 acres? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

H. APPLYING FOR CONSERVATION LAND:

Have you been certified as a qualified organization as defined in 10 V.S.A. §6301a? . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

Is parcel certified under 10 V.S.A. §6306(b)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

Have you been determined by the Internal Revenue Service to qualify as a Section 501(c)(3) organization which is

not a private foundation as defined in Section 509a of the Internal Revenue Code for at least five years preceding

certification as defined in 10 V.S.A. §6301a? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

SECTION 2. To be completed by landowner(s) - ALL LANDOWNERS MUST SIGN - if signature by other than owner(s), attach copy of recorded power of

attorney or other recorded authorization. Do not separate this form.

I hereby certify that I intend to have all my property described on this application appraised at use value except those portions specifically excluded on Line 8. I

acknowledge that I, my heirs or assigns, are subject to the provisions of 32 V.S.A. Chapter 124 and the regulations and use values as adopted and prescribed by the

Current Use Advisory Board and state statutes. When this application is signed by the landowner(s) and approved by the state, it shall be recorded in the land

records of the municipality and shall constitute a lien to secure payment of the land use change tax to the municipality upon development of the parcel. The

lien shall run with the land. The landowner shall bear the recording cost.

Owner Signature: ____________________________________________________________________

Date: ________________________

Owner Signature: ____________________________________________________________________

Date: ________________________

Owner Signature: ____________________________________________________________________

Date: ________________________

SECTION 3. To be completed by Director

From the information herein certified by the applicant, I have determined that the applicant's property is eligible for use value appraisal.

Date ______________________________

_______________________________________________, DIRECTOR, Division of Property Valuation & Review

FORM LU-AFCFB