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Home My WebLink AboutAg PDR Application Form - March 2017 (2) 1 APPENDIX A TOWN OF ITHACA AGRICULTURAL CONSERVATION EASEMENT APPLICATION FORM I. APPLICANT INFORMATION: Name(s): _________________________________ ________________________________ _________________________________ ________________________________ Home Address: ________________________________________________________________________ Street City State Zip Home Phone: ____________________________ Cell Phone: _____________________________ Email(s): _____________________________________________________________________________ Why are you interested in placing an easement on your property? ______________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Are you interested in the possibility of donating all or a portion of your conservation easement? Yes _____ No _____ Possibly, I would like more information _____ II. EASEMENT PROPERTY INFORMATION: Tax Parcel Number(s): Number: _________________________ Acreage: __________________ Number: _________________________ Acreage: __________________ Number: _________________________ Acreage: __________________ Number: _________________________ Acreage: __________________ Deed Reference(s): Book _________ Page _________ Book _________ Page _________ Book _________ Page _________ Book _________ Page _________ and/or document number(s): ____________________________________ _____________________________________________________________ Total acreage offered for easement: _______________ (please subtract out any exclusion) Reason for exclusion: ___________________________________________________________________ II. FARM INFORMATION: Farm tract address/location, if different from above: __________________________________________ _____________________________________________________________________________________ Total acreage of farm: _____________ 2 Is the property managed or farmed by any person(s) other than the owners? If so, state their names, any relationship, and responsibility: ___________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ What year was the property first purchased by a family member? _______________________________ Is there a Natural Resource Conservation Service (NRCS) Conservation Plan for the farm? Yes _____ No _____ Date: _________________ Conservation practices in use currently: ____________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Please briefly describe your farming operation. Please include any other rented lands. This is to give the Town an overall picture of your entire operation. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Crop Production: Please submit information on any crops grown on the farm, including crop types, acres grown and average yield per acre. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Livestock Production: Please submit information on any livestock and products from livestock, including livestock types, average numbers, and products or numbers sold. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Identify anything special about the property or farm operation (e.g. historical significance, uniqueness of the agricultural operation, natural features). _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 3 III. MORTGAGES, LIENS, EASEMENTS: Please list all mortgages, lien holders, easements, utility right‐of‐ways, or owners of mineral rights for the farmland tract. Mortgagees: _________________________________________________________________ _________________________________________________________________ Lien Holders: _________________________________________________________________ _________________________________________________________________ Easements: _________________________________________________________________ _________________________________________________________________ Utility Right‐of‐Ways: _________________________________________________________________ _________________________________________________________________ Mineral Rights: _________________________________________________________________ _________________________________________________________________ IV. SIGNATURES: Appraisal and Purchase Statement: Applicants, selected by the Town Board in a competitive evaluation among all applications, will be offered an appraisal to determine the development and agricultural values of the property. Applicants may accept or reject the Town’s appraisal. If rejected, applicants may order another appraisal from a qualified appraiser at their own expense. The Town may offer less, but no more than the appraised value of the property; or the Board may decide not to make an offer after an appraisal has been completed. Applicants reserve the right to accept or reject the offer by the Town. Signatures: It is necessary for ALL owners of the farmland tract to give their approval and consent to this application. I/we have read and understand the “Appraisal and Purchase Statement” and to the best of my/our knowledge, the information submitted in this application is true and correct. Signed: _________________________________________________ Date: _____________________ Signed: _________________________________________________ Date: _____________________ Signed: _________________________________________________ Date: _____________________ Signed: _________________________________________________ Date: _____________________ 4 Please submit this application to: Town of Ithaca Planning Department 215 North Tioga Street Ithaca, NY 14850 Please contact Michael Smith, Senior Planner, at msmith@town.ithaca.ny.us or 607‐273‐1747 if you have any questions or would like assistance in completing this application. March 8, 2017