Homestead Declaration Form (Real Property)

State of Utah
County of Daggett

In accordance with Utah Code § 78B-5-503, State of Utah in the County of

Daggett, I make this declaration of being a non-resident of the State of Utah owning
real estate property being vacant in Daggett County, Utah, and declare under penalty
of prudery under the law that I am filing a non-resident homestead exemption as
follows:
1. I maintain that I am entitled to a non-resident exemption under State of Utah, Utah
Exemptions Act .[I am married, and my spouse has not filed a Declaration of
Homestead.]
2. I claim as a non-resident, a homestead exemption on the land, and non-resident
real and or personal property thereon described more fully below, together with
appurtenances and improvements. Such property is my seasonal use vacant land with
personal property on it and not attached to the land as real estate and is NOT my
primary personal residence, dwelling, abode or domicile.
3. Description of the property claimed as exempt. parcel number, 02-0044-0009/T-A-
009 and legal description, 131 S. TAYLOR FLAT RD - LOT 9 PLAT A SUBD BK12
P132 BK 42 PG 465 0.23 AC. [Exhibit A] 2016 DAGGETT COUNTY REAL PROPERTY
TAX NOTICE show taxes for 2016 being paid.
3. I estimate the cash value of this property to be approximately $_1,000.00_ real
estate as vacant land and as much as $20,000.00 personal property not being real
estate attached to the land.
4. I claim a non-resident exemption of $5,000.00 as a total limit with and on real and
personal property at that location.
5. My spouse [or joint owner] may claims a total exemption up to $5,000.00.
Name of spouse or joint owner: _Juston James Fariello_, being a resident of the State
of Colorado and a non-resident of the State of Utah.
Age of spouse or joint owner: _42 years old__
Address of spouse or joint owner: _Juston J. Fariello c/o James Fariello at 2021
Jessup street in Brighton, Colorado 80601_

Dated this _______ day of _____________, ____________.

By: __________________________________________________________________________

Print Name: _James R. Fariello__

Address: _2021 Jessup Street in Brighton, Adams County, Colorado 80601_

SUBSCRIBED, SWORN TO, AND ACKNOWLEDGED before me in _Adams _ County,

State of Colorado, this ____ day of ________________, ___________.

_______________________________________________________________________
Notary Public

Residing at:2021 Jessup Street, Adams County, Colorado 80601_

Utah seasonal vacant land: 131 South Taylor Flat Road Brown's Park, Utah 84023