Public Act 490 Guide - CT.gov

APPENDIX C: NET RENTAL LAND USE VALUE SURVEY
FOR THE CALENDAR YEAR 2009
PLEASE DIRECT ANY QUESTIONS TO:
Joan Nichols at (860) 768-1105
joann@cfba org or
Ron Olsen at (860) 713-2550
ronald.olsen@ct.gov
PLEASE COMPLETE FORM AND RETURN BY OCTOBER 1, 2009 TO:
CONNECTICUT FARM BUREAU ASSOCIATION
775 Bloomfield Avenue Windsor, CT 06095
NET RENTAL LAND USE VALUE SURVEY FOR THE CALENDAR YEAR 2009
Please see attached
instructions before
completing survey
PLEASE INDICATE PERSON COMPLETING THIS SURVEY: RENTOR/LAND+OWNER RENTEE/LANDUSER (Put an X in the appropriate box)
NAME (FIRST) (M.I.) (LAST) ADDRESS (Number and Street) CITY STATE ZIP CODE
PA
490
E-MAIL:
TELEPHONE:
(1) (2) (3) (4) (5) (6) (7) (8)
NAME, ADDRESS, AND PHONE
NUMBER OF LANDOWNER
Name/Address
Phone:
Name/Address
Phone:
Name/Address John Doe SAMPLE
15 Happy Acres
Franklin, CT
Phone: 000 000-0000
Connecticut
Town
(where land
is located)
USE ONE LINE
PER TOWN
Land Class
Code
(see
instructions)
LIST ONE
LAND
CLASS PER
LINE
Number of
Acres
In Class
Type of
Crop
Total Rent
Per year
Other Owner
Items Included
in Total Rent,
IF ANY
(see
instructions)
DESCRIBE
AND GIVE
DOLLAR
VALUE
Services
Provided to
Landowner,
IF ANY
(see
instructions)
DESCRIBE
AND GIVE
DOLLAR
VALUE
Lebanon 3 50 silage $400 0 $100
plows
driveway
APPENDIX C: NET RENTAL LAND USE VALUE SURVEY FOR THE CALENDAR YEAR 2009
Connecticut Farm Bureau Association • http://www.cfba.org/pa490guide.htm • Public Act 490: A Practical Guide and Overview
47