WITHDRAWAL BY OWNER OF APPLICATION FOR
ASSESSMENT UNDER THE FARMLAND ASSESSMENT ACT
(This is not a release of lien or acknowledgment of payment)
Farmland Assessment Act
UCA §59-2-501 to 515
TO COUNTY ASSESSOR AND RECORDER: The owners of the real property described herein hereby request that the application
for taxation of the property described herein under the Farmland Assessment Act be withdrawn.
County: Utah Date:
OWNER INFORMATION AND ACCOUNT INFORMATION
Names of all current owners
Mailing address for notice Telephone
City State Zip
Name(s) originally filed under: Date original application filed: Recorder’s office entry no. of original application:
PROPERTY INFORMATION
Complete legal description of land (attach additional sheets if necessary)
Property identification num bers (attach additional sheets if necessary)
Reason for withdrawal:
CERTIFICATION Read the following and sign below.
We certify: (1) THE FACTS SET FORTH IN THIS WITHDRAWAL ARE TRUE. (2) The undersigned owners are all of the current owners of the real property described herein.
(3) This Withdrawal of Application is not an acknowledgment or receipt of payment of the rollback taxes. (4) This Withdrawal of Application is not a release of the lien for rollback
taxes. (5) We are fully aware of the five-year rollback tax provision. We understand that the rollback tax is a lien on the property until paid. After this Withdrawal is recorded,
we will provide a copy of the recorded Withdrawal to the Utah County Assessor.
OWNERS’ SIGNATURES
Owner’s signature Date County Recorder’s Use
Owner’s signature Date
Owner’s signature Date
ACKNOWLEDGMENT
STATE OF UTAH )
) ss.
COUNTY OF UTAH )
On the ______ day of ________________________, 200__, personally appeared before me
_____________________________________________________, who duly acknowledged to me
that they executed the foregoing Withdrawal.
_____________________________
NOTARY PUBLIC
Residing at: ___________________
F:\COMMON\Amyo\Withdrawal-Application.wpd
