PT283A Rev. 3/15
To the Board of Tax Assessors of ____________________: In accordance with the provisions of O.C.G.A. § 48-5-7.4, I submit this application and the completed
questionnaire on the back of this application for consideration of current use assessment on the property described herein. Along with this application, I am
submitting the fee of the Clerk of Superior Court for recording such application if approved.
Name of owner (individual(s), family owned farm entity, trust, estate, non-profit conservation organization or club) – The name of each individual and the percentage interest of each
must be listed on the back of this application. For special rules concerning Family Farm Entities and the maximum amount of property that may be entered into a covenant, please
consult the County Board of Tax Assessors
Owner's mailing address
City, State, Zip
Number of acres included in this application.
Agricultural Land: __________
Timber Land: __________
Property location (Street, Route, Hwy, etc.)
City, State, Zip of Property:
Covenant Acres
Total Acres
Land Lot
Recorded Deed Book/Page
List types of storage and processing buildings:
I, the undersigned, do hereby solemnly swear, covenant and agree that all the information contained above, as well as the information provided on the questionnaire, is true and correct
to the best of my knowledge and that the above described property qualifies under the ownership and land use provisions of O.C.G.A. § 48-5-7.4. I further swear that I am authorized to
sign this application on behalf of the owner(s) making application and that I have shown the percentage interest for each of the individuals having an ownership right to this property on
the back of this application form. I am also aware that certain penalty provisions are applicable if this covenant is breached.
_______________________________________________________________ ___________________________________
Signature of Taxpayer or Taxpayer’s Authorized Representative Date Application Filed
______________________________________________________________ Sworn to and subscribed before me this _____ day of ____________, _______
Signature of Taxpayer or Taxpayer’s Authorized Representative
(Please have additional taxpayers sign on reverse side of application) _ ______________________________________________________ Notary Public
If denied, Georgia law O.C.G.A. § 48-5-7.4 provides that the applicant may appeal in the same manner as other property appeals are made pursuant to O.C.G.A. § 48-5-311.
If transferred from Preferential
Agricultural Assessment, provide date
of transfer:
If applicable, covenant is a renewal for tax year:
Begin: Jan 1, _____ Ends: Dec 31, _____
If applicable, covenant is a continuation for tax
Begin: Jan 1, _____ Ends: Dec 31, _____
Pursuant to O.C.G.A. § 48-5-7.4(d) a taxpayer may enter into a renewal contract in
the 9th year of a covenant period so that the contract is continued without a lapse
for an additional 10 years.
If continuing a covenant where part of the property
has been transferred, list Original Covenant Map and
Parcel Number: ______________________________
Approved: _____ Date: ___________ ______________________________________________ ____________________
Board of Tax Assessors Date
Denied: _____ Date: ___________ If denied, the County Board of Tax Assessors shall issue a notice to the taxpayer in the same manner as all other notices are issued
pursuant to O.C.G.A. Section 48-5-306.
Begin: Jan 1,
Ends: Dec 31,
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ALL APPLICANTS, other than single titled owners, must list below each individual’s name that owns a beneficial interest in the property
described in this application, the percentage interest of each, the relationship of each (if the applicant is a family farm entity), and all other
information applicable to this application.
Each Person's Name having any
beneficial interest in the property
described in this application. (If this
form does not contain sufficient lines
to list all owners, please attach list
providing all information requested for
each individual.)
Relationship (complete only if
application is for a family farm
Percent interest
owned in property
in this application
Counties where you own interest in
property under other covenants and
total acres in other conservation use
Each owner's percent
interest owned and
number of acres owned by
each under other
Name / Relationship
Total Acres
% Interest / No of Acres
Check Appropriate Ownership Type:
[ ]
One or more natural or naturalized citizens.
[ ]
An estate of which the devisees or heirs are one or more natural or naturalized citizens.
[ ]
A trust of which the beneficiaries are one or more natural or naturalized citizens.
[ ]
A family owned farm entity (e.g., a family corporation, family partnership, family general partnership, family limited partnership, family limited
corporation or family limited liability company. Percent (%) of gross income from bona fide conservation uses. ______(including earnings on
investments directly related to past or future bona fide conservation uses, within this state within the year immediately preceding the year in which
eligibility is sought (include supporting tax records); provided, however, that in the case of a newly formed family farm entity, an estimate of the income
of such entity may be used to determine its eligibility (include supporting estimate records.)
[ ]
Nonprofit conservation organization designated as a 501(c)(3) organization under the Internal Revenue Code. (Provide copy of IRS determination
letter/charter with application.)
[ ]
Bona fide club organized for pleasure, recreation, and other nonprofitable purposes pursuant to Section 501(c)(7) of the Internal Revenue Code.
(Provide copy of IRS determination letter/charter with application.)
Check All Bona fide uses that apply and the percentage use, as they relate to the property described in this application.
[ ]
Raising, harvesting, or storing crops %______
[ ]
Feeding, breeding, or managing livestock or poultry %______
[ ]
Producing plants, trees, fowl, or animals (including the production of fish or wildlife) %______
[ ]
Wildlife habitat of not less than ten (10) acres of wildlife habitat (either in its natural state or under management; no form of commercial fishing or fish
production shall be considered a type of agriculture); %_____ (see board of tax assessors for appropriate documentation in accordance with O.C.G.A.
Section 48-5-7.4(b)(2 )
[ ]
Production of aquaculture, horticulture, floriculture, forestry, dairy, livestock, poultry, and apiarian products %______
[ ]
[ ] Yes
[ ] No
Is this property or any portion thereof, currently being leased? (If yes, list the name of the person or entity and briefly explain how
the property is being used by the lessee, as well as the percentage of the property leased.)
[ ] Yes
[ ] No
Are there other real property improvements located on this property other than the storage and processing buildings listed on the
front of this application? If yes, briefly list and describe these real property improvements.
[ ] Yes
[ ] No
Are there any restrictive covenants currently affecting the property described in this application? If yes, please explain.
[ ] Yes
[ ] No
Are there any deed restrictions on this property? If yes, please list the restrictions.
[ ] Yes
[ ] No
Does the current zoning on this property allow agricultural use? If no, please explain.
[ ] Yes
[ ] No
Is there any type business operated on this property? If yes please indicate business name & type of business.
• If this application is for property that is less than 10 acres in size, a taxpayer must submit additional relevant records providing proof of bona fide agricultural use.
• Although not required, the applicant(s) for a property having more than 10 acres may wish to provide additional information to assist the board of assessors in making their
determination. This information may include:
(1) Plans or programs for the production of agricultural and timber products, (2) Evidence of participation in a government subsidy program for crops or timber. (3) Receipts that
substantiate a bona fide conservation use, such as receipts for feed, equipment, etc. (4) Income tax records, such as copies of a previously filed Federal Schedule F or the appropriate
entity return (e.g., Federal Form 1065, 1120, etc.)
• The Board of Tax Assessors can only deny an application if the use of the property does not meet the definition of bona fide agricultural property or if the ownership of the property is
not in compliance with O.C.G.A. § 48-5-7.4.
I, the owner of the above described property, having satisfied all applicable taxes and penalties associated with the covenant above, do hereby file this application for release of current
use assessment with the county board of tax assessors. Pursuant to O.C.G.A. § 48-5-7.4(w), no fee is required for the clerk of superior court to file and index this release in the real
property records of the clerk’s office.
Sworn to and subscribed before me _____________________________ _______________________________
This ___ day of _________, ______ Taxpayer’s Authorized Signature Approved by: Board of Tax Assessors
_____________________________ ______________________________ ________________________________
Notary Public Date Filed Date Approved
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