Statement of Conveyance of Current
Agricultural Use Valuation Property
To be attached to conveyance fee forms DTE 100 and 100(EX).
Taxing district Parcel or account number
The grantor of the property referred to above states that the property has qualiﬁed for the current agricultural use
valuation exemption under Ohio Revised Code section 5713.31 for the preceding or the current tax year. The grantee
has been made aware prior to the closing that if the property does not continue to so qualify, either for the current or
for the succeeding tax year, it will be subject to a recoupment charge equal to the tax savings as described in
R.C. sections 5713.30 and 5713.34. Furthermore, the grantor and the grantee have considered and accounted
for the total estimated amount of such recoupment, if any, to the satisfaction of both the grantee and the grantor.
Signature of grantor or representative
Sworn to or afﬁrmed in my presence,
This day of 20 .
Endorsement by the County Auditor
Upon presentation of this instrument, the county auditor shall endorse it, forward it to the grantee or his representative,
and provide a copy of the endorsed instrument to the grantor or his representative, evidencing delivery to the county