HomeMy WebLinkAboutEmployee Housing AffidavitmIII MI II
Reception 859E17
02/2512015 04 27 10 PM Jean llberica
1 of 1 Rec Fee $11 00 Doc Fee 0 00 GARFIELD C0:,I,'v CO
laGarfield County
AGRICULTURAL EMPLOYEE AFFIDAVIT
FOR EMPLOYEE HOUSING
I, RAIZ . M. ?Of4 2'r , state that the residential structure
described below will be occupied 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, furbearing or other small animals, as
prescribed in the Garfield County Land Use and Development Code. 1 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 -1 b P
Assessors Parcel Numb r , 1 317.1 dba Is
Building Description u rt (Dv
5 P
Building Square Feet Hab)le,e
� ble '
Building Permit Number - e xr5 r`,t cr �
ISDS (Septic) Permit Number J
Owner Q. 1 in • Po
raric
Owner Address2704/ C.R
Date oC — a
Witness
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b 1( v5ed Gey
c3. eiiip IoyeE
(Signature) 61 O
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This form will be recorded with the Garfield County Clerk and Recorders office as
reference for any future title searches.