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NSYLVANIA FARMLAND AND FOREST LAND ASSESSMENT ACT OF 1974 The following information must be provided by the current landowner to the County Assessor 30 days prior to any proposed transfer, split-off or separation of land enrolled under the act. (1) Name(s) and address(es) of landowners: Current Proposed (2) Date of enrollment under the act (3) To the best of your knowledge, has any land been previously conveyed from the original tract enrolled under the act? YES NO Complete the appropriat.

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