HomeMy WebLinkAboutAgricultural Employee Affidavit for Employee Housing.pdfdill HI:elarAtMU.witlitrti ,«1RixN!d�h'+ll�} wlIII
Reception#: 852292
08107'2014 11.59 25 AM Jean Rlberico
1 of 1 Rec Fee $11 00 Doc Fee,0 00 GARFIELD 00061TY CO
1 vurpeid County
AGRICULTURAL EMPLOYEE AFFIDAVIT
FOR EMPLOYEE HOUSING
CONFORMED
COPY
^1 C. ��iiI, a)Ln state that the residential structure
described
below will be bccupied solely as an agricultural employee dwelling unit
without rent provided to an individual and related family member who is/are employed in
an agricultural use, including farms, garden, greenhouse, nursery, orchard, ranch, small
animal farm for production of poultry, fish, forbearing or other small animals, as
prescribed in the Garfield County Land Use and Development Code. I further state that
the residential structure is located on Agricultural Land defined in Article 15 of the
Garfield County Land Use and Development Code.
It is agreed that proof of employment, in the form of Internal Revenue Service Forms
W-2 or 1099 for each person employed as described above will be submitted to the
Garfield County Community Development Department upon request by the county.
Failure to provide this information for each year the unit is occupied will result in a code
violation, revocation of this status, and fines allowed by law.
It is agreed that this property will not be sold to another party without representing that
the agricultural employee dwelling structure is for agricultural employees only and may
not be used for any other purpose.
Property and Building Description:
Address Ibj,\), t ox-ktr V'oss ?A
Assessors Parcel Number al 5 !) j g 4 oty-xif)
Building Description St (.e, Fravndy tAos rwe1
Building Square Feet Habitable toLFla0
Building Permit Number
ISDS (Septic) Permit Number
Owner
Owner Address Pp eysyc
Date o—`7—lL/-
Witness /'
CX4 �� Cow
alx1 �}u -P' 7.14\ c_.. 4 -4gnature)
This form will be recorded with the Garfield County Clerk and Recorders office as
reference for any future title searches.