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OWNER[S] CERTIFICATION: <br />I [We], the applicant[s] and landowner(s), hereby certify that, to the best of my <br />[our] knowle ge, the foregoing application is complete and accurate. <br />Signature: Xzoo� C Date: <br />Signature:_ 4WO,4 L.41 W I Dater ° t <br />Signature:_ 422i�2A� n Date: - <br />Signature: �K Date:"'/ 3 <br />Signature: Date: <br />Signature: Date: <br />Signatu <br />SUPPLEMENTARY INFORMATION: <br />1. How long have you owned your farm? years <br />2. How long have you lived on your farm? years <br />3. Has your farm exceeded $1,000 in gross income in each of the past three years? <br />Yes No <br />4. How many acres on your farm are under cultivation? <br />5. What are the major crops that you plant each year? <br />6. How many acres on your farm are used for pasture? <br />42 6 6 Acres (estimated) <br />66 Coen 3so S 0 1 e 'qn S <br />For questions or more information, please contact: <br />Gail M. Hughes <br />Orange County Department of Environment, Agriculture, Parks and Recreation <br />Soil and Water Conservation Division <br />P.O. Box 8181 -306 Revere Road <br />Hillsborough, NC 27278 <br />(919) 245 -2753 Office <br />(919) 644 -3351 (fax) updated July 2012 <br />Acres (estimated) <br />10 <br />