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Occupant and Farmer of the Property Signature of Farmer Date Last Name of Occupant and Farmer First Name of Occupant and 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 Application for Special Agricultural Homestead Property Owned by an Authorized Entity and Occupied by a Qualified Person By signing below, I certify that the above information is correct. (Rev. 11/13) 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. Sign Here CR-OAEO Authorized Entity 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 Continued Please answer the following questions and attach the requested forms. YES NO 1. I am a member, shareholder or partner of the entity listed. 2. I occupy and am actively engaged in farming (I participate in the labor on a regular and substantial basis) the agricultural property listed. 3. I am a Minnesota resident. 4. Neither my spouse nor I claim another agricultural homestead in Minnesota. 5. 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.) 6. The Farm Service Agency (FSA) lists me as an operator. My FSA number is _ in My FSA number is _ in County For Office Use Only Approved Denied Name of Assessor’s ---PAGE BREAK--- The Property * CRP = Conservation Reserve Program CREP = Conservation Reserve Enhancement Program RIM = Reinvest in Minnesota Signature of Authorized Representative Date 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. By signing below, I am certifying that I am an authorized representative of the entity listed and that the entity owns the land listed. Authorized Entity Continued Please enter the following information for the agricultural property that is owned by the authorized entity and occupied and farmed by the qualified person and for which a Special Agricultural Homestead is requested. 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) 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 Last Name First Name M.I. Social Security Number % Ownership ---PAGE BREAK--- Filing Requirements • This form is to be used to apply for homestead on agricultural property that is owned by an “authorized entity” (family farm corporation, joint family farm venture, family farm limited liability company, or a partnership which is op- erating a family farm) and occupied and farmed by a “qualified person” (member, shareholder or partner) of that autho- rized entity. • The qualified person who occupies and farms the property must fill out and sign. • A representative of the authorized entity that owns the property must fill and sign the application. • This form must be completed, signed and filed by December 15 of the current as- sessment year 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. • Attach a copy of your 156 EZ form from the FSA to this application. An affidavit from your tax preparer or attorney veri- fying that you have filed a form can be substituted for the form. Form CR-OAEO Instructions 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.