Form 150-390-001 - Application For Small Tract Forestland

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Clear Form
For Assessor’s Use Only
Application for
Date received
Approved
Denied
Small Tract Forestland
Disqualified
For owners of at least 10 acres and
Date: _________ By: _________
Comments:
less than 5,000 acres of Oregon forest-
land qualified under forestland special
assessment (ORS 321.700–754)
Your application must be filed with the county assessor’s office by April 1.
Filed with the _____________________________________County Assessor for the tax year beginning July 1, 20_____.
Please print
Social Security no. or federal identification no.
Forestland owner’s name (last, first, MI)
Business identification no. (BIN)
Forestland owner’s name (last, first, MI)
Social Security no. or federal identification no.
Business identification no. (BIN)
Mailing address
City
State
ZIP code
Telephone
Total forestland acres in Oregon under your
(
)
(
)
ownership (including common ownership)___________
Business:
Home:
Check the box if you purchased land that is under the Small Tract Forestland program, and wish to continue the special
assessment. *Please see the instructions for filing deadline. Indicate the name of the previous owner from whom you
purchased the land: __________________________________________. Date of purchase: __________________
Has any part of this property been platted under ORS Chapter 92 (subdivided)?
Yes
No
—Attach a copy of your most recent forestland property tax statement(s)—
Description of Property
Fill in the boxes below to show the forestland you want to have qualified as small tract forestland. Be sure to include all contiguous
parcels. If you need more space, attach another application or photocopy this one.
Number of
Property tax account number
Map and tax lot or parcel number
Description of the land uses
acres
Declaration
As owner of the above described land, I indicate by my signature that I am aware of the potential tax liability involved when the land is
disqualified from small tract forestland assessment.
I am aware of the requirement to notify the county assessor in writing when:
• I acquire tax lots that are contiguous to small tract forestland I own;
• I acquire additional forestland that results in my owning 5,000 acres or more of Oregon forestland;
• I sell small tract forestland that results in my owning less than 10 acres of Oregon forestland; or
• There is a change in the use of any portion of my small tract forestland to a use that is not a forestland use.
I declare under the penalties of false swearing [ORS 305.990(4)] that I have examined this application (and any accompanying documents),
and to the best of my knowledge, it is true, correct, and complete.
Forestland Owner’s Signature*
Forestland Owner’s Name / Title (print)
Date
X
Forestland Owner’s Signature*
Forestland Owner’s Name / Title (print)
Date
X
Forestland Owner’s Signature*
Forestland Owner’s Name / Title (print)
Date
X
*All individuals who have an ownership interest in the above forestland must sign. Attach sheet with additional signatures as necessary.
For more information, contact your county assessor’s office.
See instructions on the back
150-390-001 (Rev. 02-11)

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