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3 <br />VOLUNTARY AGRICULTLJRAL 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 27278 <br />APPLICANT: <br />Name: ~(/ r LL i r/UI ~~R1 /I/i~ ~r~~5©~~ <br />Address: ~'S1~'! /'C~~SVN (~ (~ <br />City:(/~1~~~MrrLL~` State: lire Zip Code: Z-`/~/ <br />t„cltl•L 66vePZ~ly <br />Phone Number (Day): e E"G~ ~ ~8 9/~fFl' (Evening) ~2 qZ / ~) <br />PROPERTY INFORMATION: <br />ProperTy Location/Address: <br />Township: 2 Tax Map: a 5 ~ Bloclc L,ot: 5~ <br />Parcel Identification Number (PIN): 98 7¢s - Cn3-1;~'L t',r <br />Number of Acres: ~~' b Z Deed Book: Page: <br />Does this land have a plan on file 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 l~ted for Present Use taxation with the Orange County Tax Office? <br />Yes: 1~ , No: If "No", please complete back of form <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 comple~te/a/n/~d~acc at <br />Please direct inquiries to: <br />do Orange County Environwenl mrd Resource Conservnliou Deparbnen] <br />.3064 Revere Rand <br />Hillsboroirgly NC 27278 <br />zt~c°~' 1~'~~-Ksc~t( !3/% /-ltrRVZ~iVt,ccS <br />__ ________ <br />Hillsborough •731-8]81 Cbrspcl Hil(•967-9251 Dnrbma •688-7.331 hlebnae •227-2031 <br />