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Orange 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 /> Name Y11/15 an <br /> Address ZQ �� AA11rews CT <br /> City* %1 1 State 1K Zip Code 277,7 <br /> Phone Number(Day) q19 (Evening <br /> (Evening) <br /> E-Mail. 2.en061 5-QVI s6jC rcn q1l,(c]Y1 <br /> PROPERTY INFORMATION: + <br /> Property Location/Address �Z� t� otjl �,7rq <br /> Township_Tax Map_Block._Lot._ Township_Tax Map_Block_Lot_ <br /> Township_Tax Map• Block._Lot:_ Township-_Tax Map_Block._Lot <br /> Parcel Identification Number(PIN) "]fl Sol%)ZParcel Identification Number(PIN) <br /> Parcel Identification Number(PIN) Parcel Identification Number(PIN) <br /> Number of Acres � ` '4- Deed Book. Page <br /> Does this land have a plan on file with the Natural Resources Conservation Service or NC <br /> Forest Service? <br /> Yes. No 1/ If"No", please complete back of form <br /> Is this land I ted 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 /> 1 [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 jpccurate <br /> i <br /> Signature Date <br /> . d � rvt <br /> i <br /> Signature. 4L�vlC 2/6't�u Date <br /> g <br />