Form Dor 82916-C - Listing Of Agricultural Land - Continued

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AGRICULTURAL LAND USE APPLICATION - Continuation Page
Clear Form
File Date: _____________
County: _________________
Key Parcel: ____________________________
• First parcel listed on first Application page
OWNER:
NAME - PLEASE PRINT
Listing of Agricultural Land - CONTINUED
A.
Deeded Land You Own
Land Parcels
ASSESSOR'S USE ONLY
Land Use
Acres
Homesite
Item #
Acreage
(see codes)
(AG Land)
Assessor's Parcel ID Number
Parcel Size
App
Den
PUC
B.
If located in a different county than
Deeded Land Leased to You
the land in Part A, which county?
Land Parcels
Acres
Lease Term Dates
Land Use
Owner's Name
Item #
Leased
(see codes)
Assessor's Parcel ID Number
Begin
End
C.
Carrying
Government Land Leased to You
(or subleased to you)
Capacity
Lease Term Dates
Annual
Gov't Agency
Lease ID
e.g. BLM,
e.g. Lease Number,
Acres
Item #
AUM's
Forest Service, State Land Dept
Permit #, Allotment # / Name
Begin
End
DOR 82916-C (04/2013)

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