Form Lu-1 - Notice Of Development Or Discontinuance From Land Use Value Appraisal Program Page 2
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1
2CURRENT USE PROGRAM
FOR DEPARTMENT USE ONLY
133 STATE STREET
OID -
MONTPELIER, VT 05633-1401
NOTICE OF DEVELOPMENT OR DISCONTINUANCE FROM LAND USE VALUE APPRAISAL PROGRAM
(TO BE COMPLETED BY LANDOWNER OR DIRECTOR OF PVR)
SECTION 1
ALL FIELDS REQUIRED FOR PROCESSING
Name of Landowner
Town
Date of Development or
Discontinuance
Street or PO Box
Phone
Parcel Identification No.
Number of Acres Withdrawn
City
State
Zip Code
SPAN – School Property Account No.
Number of Acres Developed
Check appropriate reasons for withdrawal or disqualification and explain below:
Maps: If a portion of the land is being withdrawn,
Voluntary withdrawal from appraisal program
you must submit 3 copies of maps and map charts of the entire
Disqualified but no development
parcel delineating the revised enrolled and excluded acreage
Withdrawal due to development
remaining. Maps must be drawn to the orthophoto mapping
Full parcel of land withdrawn
standards.
Portion of parcel withdrawn (please describe)
Description
Reason for Withdrawal
THIS NOTICE MUST BE PRINTED AND MAILED WITH AN ORIGINAL SIGNATURE OF ALL LAND OWNERS
If signature is other than owner(s), attach copy of recorded power of attorney or other recorded authorization.
Owner Signature: _____________________________________________
Date: _______________
Owner Signature: _____________________________________________
Date: _______________
Owner Signature: _____________________________________________
Date: _______________
SECTION 2
TO BE COMPLETED BY THE PROPERTY VALUATION & REVIEW DIVISION
# Acres Withdrawn
Date of Determination
Signature – Director, Property Valuation & Review
Date Issued
# Acres
Developed
LU-1 Rev. 1/09
MAIL COMPLETED FORM AND MAPS TO:
.
Property Valuation & Review Division
Current Use Program
133 State Street
Montpelier, VT 05633-1401
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