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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 />INSTRUCTIONS: Before completing the application, please review the provisions of the Orange <br />County Voluntary Farmland Preservation Program Ordinance, then fill out the <br />form as accurately and completely as possible. Please sign and date the form, and <br />return it to the Orange County Environment and Resource Conservation <br />Department, 306A Revere Road, Hillsborough, NC 2727$ <br />APPLICANT: <br /> <br />PROPERTY INFORMATION: <br />Property Location/Address: f~ ~+~ r~ <br />Township:. ~ Tax Map: 2 ~ Block• Lot: ~ • ~~~ <br />Q 9838- '~?-'7o-s7 <br />Parcel Identification Number (PIN): Q 9P 3 8' - 5 7 - 50 5 Ci <br />Number of Acres: Deed Book: Page: <br />Does this land have lan on fide with the Natural Resources Conservation Service or NC Forest <br />Service? <br />Yes: No: If "No",please complete back of form <br />Is this land ' for Present Use taxation with the Orange County Tax Office? <br />Yes: No:~~f "No", please complete back of form <br />OWNER[S] CERTIFICATION: <br />I [We], thb applicant[s], hereby certify that, to the best of my [our] knowledge, the foregoing <br />application is complete and accurate. <br />.~ -i ~S i <br />-~ 3- a-oid <br />Please direct inquiries to: <br />do Orange County F.nvlronment and Resource Conservation Departme~et <br />306A Revert Road <br />Hillsborough, NC 27'278 <br />r~-- <br />~/ 7, 2,Er,s <br />/p . oo ,s <br />Hillsborough • 738181 Chapel HiU • 967 9251 Durham • 688-7331 Mebane ~ Z27--2031 <br />~~ <br />City: -~ ~fiJE^ State: /~ ~.. Zip Code: ~. 7 ,w2. ~' l <br />Phone Number {Day): ~f ~9-S~s ~" 3? 2 d (Evening)_ ~~m6 <br />