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Attachment 1 <br />I&L Orange Cozznty 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: C \a2` AL Ln ^f C XgEgJ <br />Address: 2S"6 ® 4 �r <br />/< 0 O P <br />City: L-I I L L S 130 R o u G t4 State: / VC Zip Code: 2 -72 7 8 <br />Phone Number (Day): a 14 9 3 '� 15 / QS (Evening <br />E -Mail: `n'lPo 2) W O 0 C ) <br />C C,.St� —Cc rm N C • Co (Y) <br />PROPERTY INFORMATION: <br />Property Location /Address: 5 6 O ,)A =(ZYZJ'rn4® -0, Cll Asboro <br />TownshipPrI%x Map:_ Block:_ Lot:_ Township:_ Tax Map:_ Block:_ Lot:_ <br />Township:_ Tax Map:_ Block:_ Lot:_ Township:_ Tax Map:_ Block:_ Lot:_ <br />Parcel Identification Number (PIN): 9!L#6 ZT602PYrcel Identification Number (PIN): <br />Parcel Identification Number (PIN): Parcel Identification Number (PIN): <br />Number of Acres: / 2 • 2 8 Deed Book: //_Y? Page: oJ O F <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 />[We], the applicant[s], hereby certify that, to the best of my [our] knowledge, the foregoing <br />application " c plete and cur te. <br />NOIa� <br />Signatur Date:_ +� _ <br />Cinnnli irc• �G/l..e /%�y/� I7AtP.' 2,0 ` Z <br />0 <br />