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2 an e County A f•icailtural Preservation Board <br /> A&Ai <br /> APPLICATION FOR CERTIFICATION AS QUALIFYING.FARMLAND <br /> AND DESIGNATION AS AN ORANGE COUNTY <br /> VOLUNTARY AGRICULTURAL DISTRICT/ <br /> ENHANCED VOLUNTARY AGRICULTURAL DISTRICT <br /> INSTRUCTIONS: Before completing the application, please review the provisions of the Orange County <br /> f Voluntary Farmland Preservation Program Ordinance, and fill out the form as <br /> accurately and completely as possible. Please sign and date the form,and return it to <br /> the Department of Environment,Agriculture,Parks and Recreation <br /> PO Box 8181 -806 Revere Road,Hillsborough, NC 27278 <br /> APPLICANT: r�Qp � �P�e f � <br /> Name: 4 `r s <br /> Address: "b Q J <br /> City: :e-ba�� State: i`t C— Zip Code. <br /> Phone Number(Day):�33� (q-I gC16 (Evening) <br /> E-Mail: MIC4'I0f-I@ iMC()he(s,)n4lirms;,GOry7i <br /> PROPERTY INFORMATION: <br /> Property Lo Location/Address:' <br /> Wba P, "( <br /> Township: ax Map:_Block:_Lot:_ Township Tax Map:_block:_Lot: • <br /> Township:`Tax Map:—Block:_Lot:— • Township:,Tax Map:—Block_,_„Lot:____ <br /> Parcel Identification Number(PIN). god O� Parcel Identification Number(PIN): <br /> Parcel Identification Number(PIN): Parcel Identification Number(PIN): <br /> Number of Acres: � Deed Book. 380'T Page: <br /> Does this land have a plan on file with the Natural Resources Conservation Service or NC <br /> Forest Service? <br /> Yes: -X If"No", please complete back of form <br /> Is this land listed for Present Use taxation with the Orange County Tax Office? <br /> Yes:_K _No: If"No!', please complete back of form <br /> I[WE]ARE SEEKING DESIGNATION AS A VOLUNTARY AGRICULTURAL DISTRICT <br /> I[WE]ARE SEEKING DESIGNATION AS AN ENHANCED VOLUNTARY AGRICULTURAL DISTRICT <br /> OWNER[S]CERTIFICATION; <br /> i[We],the applicant[s], hereby certify that,to the best of my[our]knowledge,the foregoing <br /> application is complete and accurate. <br /> Signature: . �»:, '� Date: i Z - 17 <br /> Signature: � f1� =f ff�--Z Date: r a- <br />