Submit - NHC Farmland Easement Application Form

Landowner(s) Information

Name *:

SSN#:

Street *:

City *:

State *:

ZIP code *:

Phone#:

Cell#:

Email:

Person actively farming tract:

Name:

Phone number:

Is this operation a:

Property Information

Street:

City:

State:

ZIP code:

If farm address is different from mailing address

Municipality:

Agricultural Security Area: Township

Deed Book & Page:

Book:

/

Page:

Date:

Total number of parcels submitted:

Tax Parcel ID# and acreage for each:

Map:

/

Block:

/

Lot:

Acreage:

Book:

/

Page:

Date:

Total Acreage of farm tract:

Acreage being excluded from the easement: If you are excluding acreage outside of the existing building envelope, you MUST attach a detailed map showing the exclusions. Applications without this map will be rejected.

Total acreage offered for easement:

Overview of Farm Operations

How long has the property been owned by the same family? *:

How is your land zoned? *:

Do you have public water or sewer? *:

If so how close?

Are there any cemeteries located on this property? *:

Are there any railroads located on your property? *:

Are there any underground storage tanks located on the property? *:

Are there any equine activities on the property? *:

Please describe:

Is your property located adjacent to:

Scenic, open space, historical or cultural significant land *: flood plains, wildlife habitat, high quality watershed/streams

Park/recreation area owned by Federal/State/County/Local *:

Please describe:

Are there right-of-ways or easements through this property? *:

Please describe:

Based on Act 38 of 2006, are you required to have a NMP? *: Nutrient Management Plan

Plan Date:

How many acres of land proposed is enrolled in CRP/CREP?

Program Type *:

Acreage:

Contract Period

from

through

to

Do you have a USDA/NRCS Soil Conservation Plan? *:

Program plan date:

Plan #:

Name on Plan:

What percentage of the plan is currently being implemented?

List ALL conservation practices currently in use: List only those in use on the farm being submitted for preservation.

Pasture or crops grown on land proposed for easement (past two growing seasons)

Season 1

Pasture/Crops:

Acreage:

Yield:

Season 2

List types of livestock on the farm:

Livestock:

Amount:

Other Important Information

List property owners with Preserved Easements that are contiguous to your property:

What businesses other than agricultural production are located on the farm? :

Please list information regarding any current agreements to sell the property: (Please note: We will not accept applications on properties that are currently under an agreement of sale.)

Please list any mortgages or liens held against this property: (List name of mortgage(s) or lien holder and type of lien):

Please give a list of buildings existing on the property:

Please specify any historic or environmental features found on the property:

Street location of farmland tract (include CLEAR directions from nearest State Route):

Additional Documents and/or Images

💡 You can click and drag files into this box, or hold CTRL (Windows) / ⌘ (Mac) to select multiple documents at once.

Declaration & Signature

"I,/We hereby, authorize the Conservation Plan preparer to release copies of the Conservation Plan and Nutrient Management Plan (Act 38, if applicable), to the Northampton County Farmland Preservation Board and the Bureau of Farmland Preservation as required under Act 43 criteria for easement purchase.

I/We acknowledge that I am fully aware if there is a deviation from the original amount of submitted acreage listed on this application, The Northampton County Farmland Preservation Board or their designee has the right to disqualify my application and it will be withdrawn.

I /We, authorize Northampton County Farmland Preservation to release and forward a copy of this application to officials in my municipality for possible consideration of an easement purchase at the municipal level.

I/We, do hereby verify that I/We have reviewed the application. I/We further verify that the application correctly and accurately depicts the condition of the land and that such statements are true and correct to the best of my/our knowledge, information and belief. These statements are being given by me/us to induce official action on the part of the Northampton County Farmland Preservation Board, its agents, officers, servants, and employees. I/We understand that any false statements made herein are being made subject to the penalties of 18 P.A.C.S Section 4904 relating to unsworn falsification to authorities."

Thank you for taking the time to complete this application as accurately as possible.

Date signed *:

Signature (type your name) *: Typing your name here will be treated as your legal signature.

Farmland Easement Application Form

submission

Season 1

Season 2