Agricultural Exemption Application

IMPORTANT: READ THIS COMPLETELY

We utilize eSignLive.com to process electronic signatures. You must provide us a valid e-mail address. After submitting this information to the PVA, you will receive a notification e-mail from eSignLive to acknowledge the information on your completed application. Please follow the link in that e-mail and click on the signature line to complete the process. If you do not receive an e-mail, you may wish to check your e-mail spam folder before contacting the PVA office at (859) 334-2181.

Owner Name(s)*

Mailing Address*

Phone Number*

E-Mail Address

1. Property's Address / Location*

2. Acreage used in connection with owner's dwelling house*
(this would include but not limited to lawns, drives, flower gardens, swimming pool, or other areas

3. Acreage for agricultural/horticultural use:*

4. Woodland Acreage

5. Other Acreage

6. Total Property Acreage*

Describe Current Agricultural/Horticultural use(s).*
(attach additional files if needed)

Number of Structures on Property

No Structures; Land Only
If there are no structures, check the box below.

# of Residences

# of Outbuildings

# of Mobile Homes

if applicable: year, make, model of mobile home(s)

Supporting Documentation
Please indicate by checking the boxes below the type of documentation you will be attaching.

Copy of Schedule F (Federal form 1040)

Copy of a current lease.