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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.

    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.

    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