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<br /> -. .: ,APPLICATION TOR CERTIFICATION AS QUALIFYING FARMLAND r__,
<br /> :AND DESIGNATION AS AN ORANGE COUNTY - _- -. __ .- -
<br /> VOLUNTARY AGRICULTURAL DISTRICT
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<br /> INSTRUCTIONS:lB- efore completing the application, please review the provisions of the Orange County Voluntary Farmland
<br /> . --.Preservation Program Ordinance, then fill out the form as accurately and completely as possible. Be sure to
<br /> ,- sign and date the form, and Datum it to the Orange County Planning&Inspections Department, 306F Revere
<br /> - .- ._ ,. Road, Hillsborough; N.C.
<br /> APPLICANT:
<br /> Nam C ctu - uc�as
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<br /> Address:l.Arn er-g,aYri-- 3500 Ort}C6.�ro,/ct-U'w.xckRoa;ci
<br /> It City: I t.00u1� -- n
<br /> State: .0 ZIP Code: "R:73a•.-g�0ci
<br /> - Phone Number:(Home)(/?).$43--V?� . . (Work)( /q .:6S�" 3 .� -:<> _
<br /> PROPERTY INFORMATION:
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<br /> Property Location/Address: �
<br /> - Township: B)>.yl, - Tax Map: .. b Block. � Lot: 11 D dh,a lgE"
<br /> Parcel Identification Number [PIN]: 98, ..2.--..E8-5.../? _ •
<br /> Number.of Acres: 54 .0 f -- Deed Book: Page. :,_:'-'2%-;,'''- .*- --
<br /> `-Does this land have a plan on a with the Soil Conservation Service or U.S Forest Service?
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<br /> - Yes. - "`` No -_'- If "no", please complete back of form. -
<br /> Is this land listed for farm present use-value taxation with the Orange County Tax Office?
<br /> - _ Yes: 7-•=A "t- No If "no",please complete back of form. --
<br /> OWNER[S]; TIFICATION r
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<br /> 4We] thelapplicant[s],-hereby certify-that;to the best f-my [our] ability, the foregoing
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<br /> ;. ,, .,.. , application3s-c0mpiete.and accurate: � � - _�-•
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<br /> • Signatur : `"era``Late ' . -
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<br /> _ Date
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<br /> • "'':� =Please direct inquiries to: �'
<br /> ...., r, orange Sorr&Water Coruervahon District , Y
<br /> aerr Cooperative Extension Service t3 yw's w� n.p �o `�i411- { k y
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