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Farmer of the Property Signature of Farmer Date Last Name of Farmer First Name of Farmer M.I. Social Security Number Last Name of Spouse First Name of Spouse M.I. Social Security Number of Spouse Mailing Address - Street City/Town State Zip Code County of Residence City/Town of Residence Daytime Phone Evening Phone By signing below, I certify that the above information is correct. (Rev. 11/13) Sign Here Please answer the following questions and attach the requested forms as Yes No noted in the instructions on page 3. 1. I am a member, shareholder or partner of the entity listed. 2. I am actively farming the agricultural property listed. a. I participate in the day-to-day labor and decision making on the farm. b. I contribute administration and management to the farming operation. c. I assume all or a portion of the financial risks and participate in any profits or losses. 3. I am a Minnesota resident. 4. I live within four townships or cities from the agricultural property listed. 5. Neither my spouse nor I claim another agricultural homestead in Minnesota. 6. I filed a Schedule F or Federal Form 1065 for partnerships, Federal Form 1120 for corporations or Federal Form 1120S for S corporations with my federal income tax return for the most recent tax year. (You may be required to provide this form.) 7. The Farm Service Agency (FSA) lists me as an operator. My FSA number is in My FSA number is in Owner of the Property Last Name of Owner First Name of Owner M.I. Social Security Number Mailing Address - Street City/Town State Zip Code County of Residence City/Town of Residence Daytime Phone Evening Phone Continued Application for Special Agricultural Homestead Property Leased to an Authorized Entity Homestead on Non-Contiguous Farmland - Minnesota Statutes 273.124, Subdivision 14, Paragraph Some of the information contained on this application is private data. Minnesota Statutes 273.124, subdivision 13 authorizes the collection of Social Security Numbers for use on homestead applications. Other information collected on this form is necessary to verify eligibility for the Special Agricultural Homestead provision. Some or all of the information contained on this form may be shared with the County Assessor, the County Attorney, the Commissioner of Revenue, and other federal, state, or local taxing authorities for the purpose of verifying your eligibility for this program or your other tax obligations. You can refuse to provide the information on this form. However, such refusal will cause you to be disqualified from this program. County CR-LAE For Office Use Only Approved Denied Name of Assessor’s ---PAGE BREAK--- Please answer the following questions. Yes No 1. I am the owner of the property listed and I am a shareholder, member or partner of the entity listed. 2. I am a Minnesota resident. 3. I do not claim another agricultural homestead in Minnesota and neither does my spouse. 4. I live within four townships or cities from the agricultural property listed. Parcel Identification Number Number List all Uses of Land County Enrolled in CRP, (located on tax statement) of Acres Located CREP or RIM*? (indicate which one and number of acres) The Property Signature of Owner Date I certify that I own the property listed and all the information is correct. Sign Here * CRP = Conservation Reserve Program CREP = Conservation Reserve Enhancement Program RIM = Reinvest in Minnesota The Entity Leasing the Property Name of Entity Name of Authorized Representative Daytime Phone Mailing Address - Street City/Town State Zip Code Entity Family Farm Corporation Joint Family Farm Venture Family Farm Limited Partnership which is Liability Company Operating a Family Farm Last Name First Name M.I. Social Security Number % Ownership Last Name First Name M.I. Social Security Number % Ownership Last Name First Name M.I. Social Security Number % Ownership Last Name First Name M.I. Social Security Number % Ownership Signature of Authorized Representative Date By signing below, I am certifying that I am an authorized representative of the entity listed above and that the entity leases the land listed and that the farmer listed is a shareholder, member, or partner in the entity listed. Sign Here List all shareholders, members or partners of the above entity: List any additional shareholders, members or partners on a separate piece of paper and attach it to this application. List any additional parcels on a separate piece of paper and attach it to this application. Owner of the property Continued Please enter the following information for agricultural property that you own and lease to the entity listed and for which a Special Agricultural Homestead is requested. If you answered NO to question #4 and you or your spouse are actively farming the property but are required to live in employer- provided housing, which is more than four townships or cities away from the property, then you may still be eligible. You must provide an affidavit and proof from the employer indicating that such a housing arrangement is a requirement of employment. ---PAGE BREAK--- Filing Requirements • This form is to be used to apply for homestead on agricultural property that is leased to an “authorized entity” (family farm corporation, joint family farm ven- ture, family farm limited liability com- pany, or a partnership which is operating a family farm) and farmed by a qualified person (member, shareholder or partner) of that entity. • The qualified person actively farming the property must fill out and sign. • The owner of the property must fill out and sign. • An authorized representative of the entity that is leasing the property must fill out and sign. Please attach copy of lease. • This form must be completed, signed, and filed by December 15 of the current assessment with each county in which a Special Agricultural Homestead classifi- cation is requested. You must apply every year for this classification. • Your County Assessor may require that you attach a copy of your Federal Sched- ule F or an equivalent form to this ap- plication. Contact your County Assessor’s Office to see if you are required to attach this documentation. Form CR-LAE Instructions • Attach a copy of your 156 EZ form from the FSA to this application. An affida- vit from your tax preparer or attorney verifying that you have filed a form can be substituted for the form. If Ownership, Occupancy, or Active Farmer Status Changes If this property is sold, or if occupancy or active farmer status changes, or if you change your marital status, state law requires you to notify the County Assessor within 30 days. If you fail to notify the County Assessor within 30 days, the property can be assessed the tax that is due on the property based on its cor- rect property class plus a penalty equal to the same amount. Making False Statements on this Application is Against the Law Anyone giving false information in order to avoid or reduce their tax obligations is sub- ject to a fine of up to $3,000 and/or up to one year in prison. (Minnesota Statutes 609.41) The property owner may be required to pay all tax that is due on the property based on its correct property class, plus a penalty equal to the same amount. (Minnesota Statutes 273.124, subdivision 13) Use of Information The information on this form is required by Minnesota Statutes, section 273.124 to properly identify you and determine if you qualify for this property tax classification. Your Social Security number is required. If you do not provide the required informa- tion, your application may be delayed or denied. Your County Assessor may also ask for additional verification of qualifications. Your Social Security number is considered private data. Questions? Contact your County Assessor’s Office for assistance.