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Agricultural Application for Land Ownerships of Five Acres or Less, Including Homesite AS-30

2. Owner Information
4. Name*
6. Mailing Address*
8. City*
9. State*
10. Zip Code*
12. AIN #*
13. Parcel #
15. Telephone*
16. Email
19. ---A SEPARATE FORM IS REQUIRED FOR EACH PARCEL---
23. 1. Total Acres in Parcel*
24. 2. Total Acres Devoted to Agriculture*
26. 3. Has all the acreage exclusive of the building site (if a developed homesite exists) been devoted to an agricultural use for the last three growing seasons (I.C., 63-112(1)(b) )?*

    1. Yes
    2. No
28. If “Yes,” what crop was grown?
31. A. Has the land agriculturally produced for sale or home consumption the equivalent of 15% or more of the owner’s or lessee’s annual gross income? *

    I.C., 63-604(1)(b)(I)

    1. Yes
    2. No
34. OR
37. B. Has the land agriculturally produced revenues in the immediately preceding year of $1,000 or more? *

    I.C., 63-604(1)(b)(ii) NOTE: “Home Consumption” excluded from the total!

    1. Yes
    2. No
41. Agricultural use is described in I.C., 63-604, (a)(b). NOTE: Land utilized for grazing of a horse or other animals kept primarily for personal use or pleasure shall not be considered land which is actively devoted to agriculture (I.C., 63-604 (3)).
    NOTE: Land utilized for grazing of a horse or other animals kept primarily for personal use or pleasure shall not be considered land which is actively devoted to agriculture.
43. MANDATORY -- YEARLY
    The owner must submit proof of annual gross income or gross income from crops or grazing. Please provide the Assessor’s Office with copies of income tax returns with F-4 forms attached from the preceding year(s), or with copies of cancelled checks to support the reported income.
45. Please upload your proof of income here:
47. Additional Comments:
51. Under penalty of perjury, I certify that to the best of my knowledge and belief the information that I have provided herein is true, correct, complete and that I agree to have my parcel INSPECTED by the Kootenai County Appraiser.
53. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree
    2. I do not agree
55. Signature*
56. Date*
    Date
58. Signature
59. Date
    Date
61. Landowner must notify the Assessor's Office of ANY changes to the parcel to maintain the Agricultural Exemption.
64. ---REMEMBER TO CHECK YOUR ASSESSMENT NOTICE YEARLY---
Leave This Blank:


66. 1. Receive an email copy of this form.
67. Email address

    This field is not part of the form submission.

68. Submit

* indicates a required field