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6 <br /> Orange County Agricultural Preservation Board <br /> APPLICATION FOR CERTIFICATION AS QUALIFYING FARAD.AND <br /> AND DESIGNATION AS AN ORANGE COUNTY <br /> VOLUNTARY AGRICULTURAL DISTRICT <br /> WSTROCPIONS: Before mmpleflug no application,pWw review We Promises of We Orange <br /> Como VOLmmrY Portland Premrvatim PruBam ovdimnmp then In ml due <br /> Pormu ammrafe ll'ma completelykppmiblF P Ratio yW tlate Wefarm.and <br /> rewrn a me 6A Ron em Road,Envtrovmentlo RRnourtaCooaevattoo <br /> Dcpv1mev13'J6A Renre Reed.BWrbmogL,NC Mn <br /> APPLIGNT: <br /> No= Le H. M'\1a' <br /> Address 3boD -'i exson Aoad <br /> Cd)r Hn.dle M'Hsr sum. NpCcds: 2 541 <br /> Pbmm Numbs tDaYY —132-8832 Monsudl same <br /> EMaiL <br /> PROPERTY INFORMATION: <br /> NvpenylomdoNAdNas: i(ICO Pld.,;M d LWlt R' i th A <br /> Towmhip: Gli'NLZV In bap: Bloch, L Do e r md <br /> Parcel Wmtl NU ber(PIN): 1 f <br /> Se. <br /> J R <br /> Membmof Acros: Ded Bouk: Page: <br /> Doesrat lam have a plan on file wM roe Natural Resources Commonness Service or NC Forms <br /> Stir <br /> Ym:--oL_No: If'We.plane complete book of form <br /> a obis lam load fm frusta Use around wW the Orange County Toot orta9 <br /> Ym:_,/—Nc IfNo",please mmplele Wck of form <br /> OWNERM CRRT6'ICATION: <br /> I[Wel.the awlicmu[s],hereby mmdfY flat to the End of my[out]kuowle3ga,the foregoing <br /> application u c'embse am accurate. <br /> sigumr.<i A-1 22?:O/ Datc Z ' O Z <br /> si ualua: Date: <br /> plena direct inquiries he <br /> Me o"W COwry E1,00,MIN E1, rind Rmero.moem iaa uepmow <br />