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2. Date of Request:
4. Map Reference Number(s):
6. 1.
7. 2.
8. 3
9. 4.
13. The reason for this request is:
15. Is property being sold?

    1. Yes
    2. No
16. Is it a portion of a larger parcel?

    1. Yes
    2. No
18. If yes, provide plat indicating new parcel.
20. When did the use change?
21. What is the new use?
23. Mailing Address of new owner:
25. Name and address of person making request:
27. Phone number:
28. Email:
30. Comments:
34. This request must be completed in its entirety, inclusive of plat, in order to process prior to normal office procedures; otherwise this request will be ignored.
36. Owner Signature:*
38. Agent Signature (include POA or relationship)*
40. A change in use of agricultural real property which subjects it to the rollback tax causes a reappraisal of the property at current market value. See 12-37-3150 (A) (9) of the S.C. Code & Laws. Revised (01-13-09)
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42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field