Farm Building Exemption Form (Real Estate) (PDF)

450 Columbus Boulevard, Hartford, CT  06103 
Affirmative Action/Equal Employment Opportunity Employer 
STATE OF CONNECTICUT 
DEPARTMENT OF AGRICULTURE 
Application to the Assessor for 
Certain Farm Buildings 
Form M-28 Buildings, rev. 10/24/19 
(860) 713-2500 
www.CTGrown.gov 
This application for exemption of certain farm buildings, as defined in Section 1-lq, up to the assessed value of $100,000 per 
farm building within the provisions of Section 12-91 of the Connecticut General Statutes, must be filed ANNUALLY by 
November 1st with the assessor or board of assessors of the municipality in which the building is located. Failure to file this 
application with the Assessor within the time limit prescribed shall be considered a waiver of the right to such exemption for 
the assessment year. 
NAME:  (Name of Owner(s) or Trustee(s)) 
TOWN OF: 
PHONE NO: 
E-MAIL: 
MAILING ADDRESS: (Number and Street or P.O. Box) 
(Town/City)  
(State)  
(Zip Code) 
Farm Name/ Town(s) in which the farm buildings are located: 
Property Address/Map, Block, Lot Number: 
Building Name 
Building Description/Size 
Building Purpose/ Exclusive Use 
Have you filed, or do you intend to file, any application for exemption as provided under 
the above statute, in this or any other town or city, as trustee, as an individual farmer, or 
as a member of a group of farmers, partnership or family corporation, other than under 
the ownership contained in this application? 
YES 
     NO 
Do you derive at least $15,000 in gross sales, or did you incur at least $15,000 in 
expenses related to such farming operation during the previous calendar year?  
YES 
     NO 
Are the farm buildings kept within the State of Connecticut? 
YES 
     NO 
I DO HEREBY declare in accordance with Section 12-91 of the CT General Statutes under penalty of perjury that the statements herein 
made by me are true according to the best of my knowledge and belief. 
DATE: 
SIGNED: (owner(s) or trustee(s)  
X   
Subscribed by Sworn 
To before me:    
DATE: 
SIGNED:  (Notary Public) 
X   
My Commission expires:  
DATE: 
SIGNED:  (Assessor(s)) 
NOTE: ATTACH ADDITIONAL SHEETS IF NECESSARY