REQUEST FOR FARM USE ASSESSMENT IN AN EFU ZONE Douglas County Oregon

Owner, Account(s) and Property Use Information Name and Address Return this Form to:

ENTER YOUR NAME AND ADDRESS BELOW (Applicant MUST have an ownership interest in the property) Office of Assessment

Douglas County Courthouse 1036 SE Douglas Ave. Rm 206

Roseburg, OR 97470 Telephone: (541) 440-4222

Office Hours: 8:00AM – 5:00PM, Mon – Thurs www.co.douglas.or.us/puboaa

SECTION A – PROPERTY DESCRIPTION

Account Numbers Map & Tax Lot Number Situs Address Total Acreage

# of Acres Farmed

Was the farm land leased in 2019? Yes No -- If yes, provide the following information:

If this box is checked, please submit a copy of your current and prior years Schedule F forms.

The following Sections B, C, D and E relate to the above property tax accounts.

SECTION B – HOMESITE USE (See Attached)

This section must be completed whether the owner farms the land or leases it to a farm operator. The questions relate to any residences located on the above property tax accounts. Note: (Attach information for each additional residence if there are more than 3 residences).

SECTION C – FARM USE ACTIVITY Please fill out the farm activity information below for any land actively being used for “farm use” as defined below. (ORS 308A.056).

“Farm Use” means the current employment of land for the primary purpose of making a profit in money.

OVER TO CONTINUE

Annual Lease Amount $ __________ # of Non-Irrigated Acres being leased _________ # of Irrigated Acres being leased _________ Description of farm use activity on leased land _____________________________________________________________________ Description of any outbuildings and/or equipment usage included in the lease ____________________________________________ Name of Farm Operator _________________________________________ Phone # _____________________

Farm-EFU

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EFU Farm Use Request.doc 08/25/17

Specifically list the “number” of acres and corresponding farm use activity (i.e.: 10 acres row crop, 5 acres orchard, 10 irrigated acres pasturing 5 cows, 2 acres of farm related buildings, and 1 acre farm residence for a total of 28 acres in farm use). If you are engaged in livestock farming indicate the number and type of animals you are currently running (i.e.: 5 Cows, 20 Sheep, etc.)

• Please indicate below the farm products and gross income you received (in $’s) for the current and prior calendar years from farmactivity on your land.

• You must deduct the original purchase price from the gross sale price of any livestock sold.• Do not list firewood or timber sales (these are not farm products).

YEAR

FARM PRODUCTS SOLD FARM PRODUCTS CONSUMED** TOTALS

WHAT CROP, LIVESTOCK or SERVICE WAS

SOLD?

QUANTITY SOLD

TOTAL GROSS

RECEIPTS ( IN $’s)

( A )

WHAT WAS CONSUMED OR USED ON THE FARM?

QUANTITY USED

TOTAL VALUE ( IN $’s )

( B )

TOTAL VALUE ( IN $’s ) OF

PRODUCTS SOLD AND CONSUMED

( A + B )

2019

2018

2017

2016

2015 ** For ‘Consumed’ products to be reported here they must have been produced on your farm land.

Is the land farmed with the intent to make a profit? (Are you selling YES NO (If No, attach a brief explanation) crops, livestock, poultry, farm products or certain services?)

Did you report this farm use income on a schedule “F” Or other YES NO (If No, attach a brief explanation) income tax form(s)?

Are you continuing these farm use activities this coming year? YES NO (If No, attach a brief explanation)

Explain your involvement with the management of the farming operations?

SECTION D – OTHER QUALIFYING FARM USE LANDS Approximately how many wasteland acres do you have? __________ “Wasteland” are those acres that are dry or covered with water, neither economically tillable or grazeable, lying in or adjacent to and in common ownership with farm use land and that is not currently being used for any economic farm use.

Approximately how many woodlot acres do you have? __________ (No more than 20 acres) “Woodlot” is any land constituting a woodlot, not to exceed 20 acres, contiguous to and owned by the owner of land specially valued for farm use even if the land constituting the woodlot is not utilized in conjunction with farm use. Record any acres receiving forestland special assessment in Section E (below).

SECTION E –NON-FARM ACTIVITY Please explain use and acres for land devoted to non-farm activity.(i.e.: forestland not identified as farm woodlot; farmable land not being used for farming activities; land being used for commercial or retail use; land under farm processing facilities greater than 10,000 square feet of processing area or processing less than on quarter of your farm’s crops; homesites not farm related, etc.) Note: Total acres for all tax accounts identified in SECTION A need to be accounted for.

= = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = DECLARATION: I declare under the penalties for false swearing as contained in ORS 305.990(4), that I have examined this

document, including any attachments, and to the best of my knowledge it is true, correct and complete. (Required)

SIGNATURE OF OWNER:___________________________________Day Phone No.____________________ Date:_____________ FF-EFU