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4 <br />rALOra2Le County Agricultural Preservation Board <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 />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 <br />Department of Environment, Agriculture, Parks and Recreation <br />PO Box 8181 - 306 Revere Road, Hillsborough, NC 27278 <br />APPLICANT: <br />City: _ _- State: Zip Code: I <br />Phone Number (Day): G f - (Evening) 3a/VVQ- <br />E-Mail: it W 'f- i ' t'I a I 1W ;byvooB 1 a <br />PROPERTY INFORMATION: <br />Property <br />MCZ�Z3l <br />7, 3.5 -3SA <br />Township:_ Tax Map:_ Block: Lot: Township:_ Tax Map:_ Block:_ Lot: — <br />Township:_ Tax Map:_ Block:_ Lot:— q Township:_ Tax Map:_ Block:_ Lot _ <br />Parcel Identification Number (PIN): 8582-05 Parcel Identification Number (PIN): <br />Parcel Identification Number (PIN): Parcel Identification Number (PIN): <br />Number of Acres: 50 .0 Deed Book: Page: �35 <br />Does this land have a plan on file with the Natural Resources Conservation Service or NC <br />Forest Service? <br />Yes: No: "� If "No ", please complete back of form <br />Is this land listed for Present Use taxation with the Orange County Tax Office? <br />Yes: 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 />S /� j d / f <br />Signatu <br />Signatu <br />