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1 Subdivision Exemption Claim Application 1. Claimant(s): (if more than two claimants, please attach additional sheets) a. Name Occupation Address Phone Email b. Name Occupation Address Phone Email 2. Surveyor: Name Firm Address Phone Email 3. Existing Parcel(s): (if more than two parcels, please attach additional sheets) a. Address Section Township Range Other legal description Zoning District Sub-district (Zoning Designation) Assessor Parcel # _ DOR/Geocode i. How and when was the parcel created? (example: Occasional Sale, COS 999, 5/1/92) ii. Has a subdivision application for the parcel been withdrawn of denied? Yes No b. Address Section Township Range Other legal description Zoning District Sub-district (Zoning Designation) Assessor Parcel # _ DOR/Geocode i. How and when was the parcel created? (example: Occasional Sale, COS 999, 5/1/92) ii. Has a subdivision application for the parcel been withdrawn of denied? Yes No File No.: ---PAGE BREAK--- 2 4. Type of Exemption and Reason or Justification Check and complete the section for the requested exemption. (If applying for more than one, the exemption fee must be paid for each request) Gift or Sale to Immediate Family Member (“Family Transfer”) Recipient(s) Relationship to Claimant Age • Attach copies of all below documents recorded within the past year related to the property: o Deeds o Contracts o Restrictions o Covenants • If recipients are under age 21, attach documentation of trust, custodianship pursuant to the Montana Uniform Transfers to Minors Act., etc. • Attach additional documentation or narratives addressing the rebuttable presumptions described in Section 13.G.8 of the Subdivision Regulations. • Date Claimant(s) became sole owner(s) of parcel to be divided • Have any of the recipients previously received an exempted parcel(s) in Gallatin County? Yes No • Other than the parcels that will be granted or sold to the Claimant’s immediate family members, does the exemption result in more than one parcel of less than 160 acres in size? Yes No Note: See Procedures for Family Transfer Exemption Claims Agricultural Exemption Covenant running with the land, revocable only by mutual consent of the Commission and the property owner, that the land will be used exclusively for agricultural purposes. No Structure requiring water or sewer facilities shall be utilized on this parcel. Description of current and/or proposed agricultural use: Relocation of Common Boundary Lines Outside or Adjoining a Platted Subdivision Description of the need or reason for the relocation: ---PAGE BREAK--- 3 • Attach documentation showing the need or reason for the relocation: o Aerial Photo o Site Plan o Surveyor Error o Structure Encroachment o Enhancement of Configuration of the Property o Other (please describe): Relocation of Common Boundary Lines within a Platted Subdivision Description of the need or reason for the relocation: • Attach documentation showing the need or reason for the relocation: o Aerial Photo o Site Plan o Surveyor Error o Structure Encroachment o Enhancement of Configuration of the Property o Other (please describe): Lot Aggregation Description of the need or reason for the relocation: • Attach documentation showing the need or reason for the relocation: o Aerial Photo o Site Plan o Other (please describe): If aggregating by deed, no Certificate of Survey, Signed Surveyor’s certificate, or mylar required. Security for Construction (“Mortgage Survey”) • Attach signed and notarized statement from lending institution confirming that the exempt parcel is necessary to secure a construction loan for buildings or other improvements on the parcel. No proposed deeds are required. Other Description of the need or reason for the relocation: ---PAGE BREAK--- 4 5. Intentions for Use Claimants' and recipients' intentions for the use of each parcel (including existing, new and remainder parcels) (i.e. will the parcel(s) be used for agriculture, residences, etc.?): 6. Intentions for Disposition Claimants' and recipients' long-term and short-term intentions for the disposition of each parcel (including existing, new and remainder parcels) (i.e. after this transaction is finalized, will the parcel(s) be retained by recipient, sold, gifted, etc.?): 7. Required Attachments for All Exemption Types Certificate of Survey or Amended Plat (to include:) One mylar with all required certificates County Commission’s certificate Clerk & Recorder’s certificate Surveyor’s certificate, signed Treasurer’s certificate, signed Claimants’ Certificates of Exemption, signed and notarized Digital Copy of Plat and application materials (to include:) Copies of recorded deeds documenting present ownership in all affected parcels. Copies of proposed deeds for exchange of ownership, if any exchange is proposed. Copies of proposed deed restrictions or covenants, if any. Site plan showing all existing and proposed structures and proposed property lines (if parcel is in a Zoning District) 8. Acknowledgements • I understand that the State of Montana provides that certain divisions of land, which would otherwise constitute subdivisions, are exempt from local subdivision review and approval, unless the transactions are an attempt to evade the Montana Subdivision and Platting Act. ---PAGE BREAK--- 5 • I affirm that this exemption claim is not an attempt to evade the Montana Subdivision and Platting Act. • I recognize that I may be subject to penalty if my actions are deemed to be an effort to evade subdivision review, as set forth in the Montana Code Annotated: • 76-3-301(3) If transfers not in accordance with this chapter Chapter 3, Local Regulation of Subdivisions] are made, the county attorney shall commence action to enjoin further sales or transfers and compel compliance with all provisions of this chapter. The cost of such action shall be imposed against the party not prevailing. • 76-3-105 Violations. Any person who violates any provision of this chapter Chapter 3, Local Regulation of Subdivisions] or any local regulations adopted pursuant thereto shall be guilty of a misdemeanor and punishable by a fine of not less than $100 or more than $500 or by imprisonment in a county jail for not more than 3 months or by both fine and imprisonment. Each sale, lease, or transfer of each separate parcel of land in violation of any provision of this chapter or any local regulation adopted pursuant thereto shall be deemed a separate and distinct offense. • 45-7-201 Perjury. 1. A person commits the offense of perjury if in any official proceeding he knowingly makes a false statement under oath or equivalent affirmation or swears or affirms the truth of a statement previously made, when the statement is material. 2. A person convicted of perjury shall be punished by imprisonment in the state prison for any term not to exceed 10 years or shall be punished by a fine of not more than $50,000, or by both such fine and imprisonment. 3. Falsification is material, regardless of the admissibility of the statement under rules of evidence, if it could have affected the course or outcome of the proceeding. It is no defense that the declarant mistakenly believed the falsification to be immaterial. Whether a falsification is material in a given factual situation is a question of law 4. It is not a defense to prosecution under this section that the oath or affirmation was administered or taken in an irregular manner or that the declarant was not competent to make the statement. A document purporting to be made upon oath or affirmation at any time when the offender presents it as being so verified shall be deemed to have been duly sworn or affirmed. 5. No person shall be guilty of an offense under this section if he retracted the falsification in the course of the proceeding in which it was made before it became manifest that the falsification was or would be exposed and before the falsification substantially affected the proceeding. 6. Where the defendant made inconsistent statements under oath or equivalent affirmation, both having been made within the period of the statute of limitations, the prosecution may proceed by setting forth the inconsistent statements in a single count alleging in the alternative that one or the other was false and not believed by the defendant. In such case it shall not be necessary for the prosecution to prove which statement was false but only that one or the other was false and not believed by the defendant to be true. 7. No person shall be convicted of an offense under this section where proof of falsity rests solely upon the testimony of a single person other than the defendant. • 45-7-202 False swearing. 1. A person commits the offense of false swearing if he knowingly makes a false statement under oath or equivalent affirmation or swears or affirms the truth of such a statement previously made when he does not believe the statement to be true and: a. the falsification occurs in an official proceeding; b. the falsification is purposely made to mislead a public servant in performing his official function; or c. the statement is one which is required by law to be sworn or affirmed before a notary or other person authorized to administer oaths. 2. Subsections through of 45-7-201 apply to this section. 3. A person convicted of false swearing shall be fined not to exceed $500 or be imprisoned in the county jail for any term not to exceed 6 months, or both. ---PAGE BREAK--- 6 9. Affidavit , Claimant(s), being first duly sworn upon oath, deposes and says as follows: I, as Claimant, have read the foregoing Subdivision Exemption Claim Application and affirm that it is true and correct. Claimant’s Signature’ State of County of Subscribed and sworn to before me on this day of (seal) Notary Public for the State of Residing at My commission expires Claimant’s Signature’ State of County of Subscribed and sworn to before me on this day of (seal) Notary Public for the State of Residing at My commission expires