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Application no.
County
Tax year
DTE 109
Rev. 5/13
Initial Application for the Valuation of Land at Its Current Agricultural Use
File with the county auditor prior to the fi rst Monday in March. Include a $25 fi ling fee.
1. Owner’s name
Phone
E-mail
2. Owner’s mailing address
3.
Parcel number
Acres
Parcel number
Acres
4. If the TOTAL acreage being used exclusively for commercial agriculture purposes is less than 10 (ten) acres, show the
total gross income from agricultural products. Attach verifi cation of gross income for the last 3 (three) years.
Year
Farmed Acres
Units/Acre
Price/Unit
Gross Income
Use of Land (Crop)
Last year
2 years ago
3 years ago
5. List the acreage in each crop or land use for the past three years. The entire acreage above must be accounted for below.
Last year –
2 years ago –
3 years ago –
Land Use:
Acres
Acres
Acres
Commodity crops – corn/soybeans/wheat/oats
Hay – baled at least twice a year
Permanent pasture – used for commercial animal husbandry
Noncommercial woodland – contiguous to 10 (ten) acres of farmed land
Commercial timber
Other crops – nursery stock/vegetables/fl owers
Homesite(s) – minimum 1 (one) acre per house
Roads/waste/pond
Land in a conservation program – CRP/CREP/etc.
(provide a copy of contract)
Other use
Total acres – must match acres above
6. Is this land farmed by someone other than the owner?
(yes/no) If yes, provide contact information (name and
phone number)
I declare under penalties of perjury that I have examined this application and, to the best of my knowledge and belief, it is
true, correct and complete. I authorize the county auditor to inspect this property and I agree to provide documentation of
income, if requested, to verify the accuracy of this application.
Signature of owner
Date
County Auditor’s Use Only
Receipt for Payment of Fee: I hereby certify that the owner paid the fi ling fee of $25 on the date this application was fi led.
County auditor
Date fi led with county auditor
Name on tax list
Taxing district
Parcel number
Number of acres