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Owner's Name ________________________________________________________________________


Address _______________________________________________________________________________


Phone # _________________________________Cell Phone #____________________________________


Email _________________________________________________________________________________



Property Address  (if different from owners address)____________________________________________



I - Information Relating to the Development Potential of the Property


total acres ________________        number of parcels _________________


number and type of dwelling (principal residence, guest house, tenant house, etc.) on each parcel_______________________________________________________________________________




Do you wish to retain any of those development rights to build a home in the future______ yes ______ no

please note - the value of the easement will be significantly reduced by any development rights retained


Is the land currently subject to any easement restrictions (eg pipeline, transmission tower, CREP, historic or

environmental protection easements)? __________  yes  ____________no 


If yes, please describe the easement in detail  _________________________________________________






II - Information Relating to the Land Features, Management and Resource Values


Approximately what percentage of the site is currently used for crop and/or animal production

(includes pasture land) ________________


Is there a Soil Conservation and Water Quality  (SCWQ) Plan currently in effect? ______ yes _____no

If  there is a SCWQ please attach a copy.  A SCWQ will need to be prepared for this property if an easement is acquired.


Are there significant farm buildings, or farm infrastructure on the site (corn cribs, implement shed, dairy barn, etc...)?


_______yes ________no


If yes, please list_____________________________________________________________________






Approximately how many acres of the site are currently or potentially commercial woodland? _______________


Is the Property currently subject to a Forest Conservation Management Agreement, or Forest Resource Management Plan?

__________  yes  ____________  no


Please note when the Property contains more than 5 acres of contiguous Woodland a Forest Stewardship Plan is required.


Is the property visible from a public road? _________yes_____________ no


Name of road or roads ______________________________________________________


III - Natural Resource Characteristics of the Site


Approximate linear feet of streams located on the property ________________ feet

please note - as a condition of the easement you will be expected to maintain or establish buffers along the edge of  all streams. 


Approved stream crossings will be allowed.


Approximate acres of wetland on the property __________________ acres


Are you willing to prohibit livestock from streams on your property, other than at approved stream crossings? 

  __________ yes __________ no


If you are currently prohibiting livestock from all or a part of the streams on you property please indicate the a

pproximate number of current feet of fencing that protect streams.   ________________  feet.


V - Historic Features


Is your property located within a National Historic District or Village  ________ yes ___________no

If yes, please name ________________________________________.


Does your property include a contributing structure to a National Historic District  ______yes _____no

If yes, please name ________________________________________.


Is your property a County, State of Federal Historic Landmark?  _________yes __________no


Is your property a Bicentennial or Century Farm?   ___________ yes ____________no


VI - Special Features


Is this an owner - operated farm?  ________ yes _____________ no


Are there any specialty or unique farming operations?  ___________ yes ____________no

If yes, what are the operations? _______________________________________________


Is there any imminent development threat?  ____________ yes _______________no

if yes, please describe_______________ _________________________________________________





VII - Additional Information


Was the property ever used for any non-farm operations?  _______ yes ___________no

If yes, please describe _________________________________________________________________


Do you have plans to locate any additional structures on the property? ______ yes _______ no

If yes, please describe and indicate proposed location________________________________________



Please note that you may be required to obtain approval from the Land Preservation  Trust prior to building any major new structures on the property.


Names and addresses of any holders of mortgages, liens, deeds of trust, or other encumbrances on the property:  please note that any and all lien (mortgage) holders will be required to subordinate their interests to an easement. _______________________________________________________________





Have you completed an environmental assessment on the property for any reason?  _____ yes _______no

If yes, please attach. If such an assessment has not been completed, please note that one will be conducted prior to easement settlement.


 Other information regarding your property that you feel would be helpful in evaluating your application










I hereby certify that the above information is correct to the best of my knowledge and agree to a site visit and verification of all information regarding my property by sponsor organization members, staff, or representatives.


Owner's Signature (s) ________________________________   Date __________________


                              ________________________________            __________________


                              _________________________________          __________________




 Please submit completed applications to:


Ann Jones

2921 Greenway Drive

Ellicott City,  MD  21042


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