Petition To Dedicate Land For Agricultural Use
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1RP Form 19-60 (Rev 06/2014)
TAX MAP KEY/PARCEL ID
Dept of Finance
ISLE
Z
S
PLAT
PARCEL
CPR
3
COUNTY OF HAWAII
DEPARTMENT OF FINANCE
REAL PROPERTY TAX DIVISION
nd
101 Pauahi St., Ste. No. 4, Hilo HI 96720
74-5044 Ane Keohokalole Hwy.,Bldg. D, 2
Flr., Kailua-Kona, HI 96740
Phone: (808) 961-8354
Phone: (808) 323-4881
PETITION TO DEDICATE LAND FOR AGRICULTURAL USE
ST
DEADLINE TO FILE IS SEPTEMBER 1
(If approved, this will be effective the following July 1st)
__________________________________________________________________________________________________________
1. OWNER’S NAME(S):
4. STATE OF HAWAII GENERAL EXCISE TAX
LICENSE NO. ______________________
____ Attach a copy of General Excise Tax
2. MAILING ADDRESS:
License (Required)
5. Check County Zoning District
____
Agricultural
3.
DAYTIME PHONE NUMBER:
____
Non-Agricultural
__________________________________
________________________________________________________________________________________
6.
USE
DEDICATED AREA
UNUSED AREA
WASTE AREA
TOTALS
PLOT PLAN: Please submit a sketch of your lot showing the locations and areas of each specific agricultural use type.
Be sure to include the location of any homesite, unused and/or waste area.
7. COMPLETE THIS ITEM ONLY IF PETITIONER’S LAND IS LEASED.
a.
Lessor’s name and mailing address: __________________________________________
b.
Term of lease (years): _______________ c. Expiration of lease: _____________
c.
Is lease recorded at the Bureau of Conveyances? ____Yes ____No If no, please submit a copy of lease
____________________________________________________________________________________________________________
8.
COMPLETE THIS ITEM ONLY IF YOU ARE CHANGING USE.
With this section completed you are hereby petitioning
to change use pursuant to Section 19-60 (f).
Petition No. ____________ Year of Original Dedication______________
Existing Use
Dedicated Area
New Use
New Area
_________________________________________________________________________________________
To facilitate investigation of this petition, I hereby grant right of entry to land described above and will provide any
documents as required by the Hawaii County Code.
I hereby declare that my land can be best used for the foregoing purposed or changes and if this petition is
approved, I will use my land for such purposes, and in accordance with Section 19-60, Hawaii County Code.
I understand that failure to observe the restrictions of the use of this land shall cancel the dedication and special
tax assessment privilege pursuant to Section 19-60 (g)(3), and additional taxes and penalties, due and owing as a result of
a breach of the dedication shall be a paramount lien upon the property pursuant to Section 19-37, Hawaii County Code.
Signature of Owner/Lessee/Agent
Date
FOR TAX OFFICE USE ONLY
Date Received: _____________________________________
By: _______________________________________________
Signature of Owner/Lessee/Agent
Date
Petition No. _________________
Effec. Date ___________
Signature of Lessor (if leasehold)
Date
Hawai‘i County is an Equal Opportunity Provider and Employer
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