CLINTON COUNTY AGRICULTURAL LAND PRESERVATION BOARD Agricultural Conservation Easement Application Form

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CLINTON COUNTY AGRICULTURAL LAND PRESERVATION BOARD Agricultural Conservation Easement Application Form A separate application shall be required for each farmland tract offered for easement purchase. The application shall consist of a completed application form, $50.00 Non-refundable fee, locational maps and a soils report form. I. General Information Name(s) (all names on the deed of the farm): Social Security # Social Security # Social Security # Address (Street/R.D.) (City) (State) (Zip Code) Telephone #(s) (please list contact person and best times to reach) Please don t transmit this page (above) with Social Security Numbers via email. It can be submitted at a later date, when requested. If mailing the application through US First Class Postal Mail, please include this page.

The following may be submitted to the Clinton County Agriculture Preservation Board and to the State Farmland Preservation Board CLINTON COUNTY AGRICULTURAL LAND PRESERVATION BOARD Agricultural Conservation Easement Application Form A separate application shall be required for each farmland tract offered for easement purchase. The application shall consist of a completed application form, $50.00 Non-refundable fee, locational maps and a soils report form. I. General Information Name(s) (all names on the deed of the farm): Address (Street/R.D.) (City) (State) (Zip Code) Telephone #(s) (please list contact person and best times to reach)

CLINTON COUNTY AGRICULTURAL LAND PRESERVATION BOARD Agricultural Conservation Easement Application Form A separate application shall be required for each farmland tract offered for easement purchase. The application shall consist of a completed application form, locational maps and a soils report form. I. General Information Name(s) (all names on the deed of the farm): Address of farm: Phone of contact person: II. Farm Information County Township Name of Agricultural Security Area This is a requirement and will be verified before this application is deemed valid. Street or 911 location of farmland tract _ Directions from nearest state route Total acreage of farmland tract Deed reference: Book Volume Page Tax parcel numbers: number and acreage number and acreage III. Signature(s) It is necessary for all farmland owners to give their approval and consent to this application. Signatures are also necessary at the end of the application. Signed Date Signed Date Signed Date

IV. Conservation Plan Date of USDA Natural Resources Conservation Service Plan Date of any Nutrient Management Plan Conservation Practices in use currently - V. Mortgages, Liens and Mineral Rights Please list all mortgages, lienholders, or owners of mineral rights for the farmland tract(s). Mortgage Mortgage Lienholders Lienholders Mineral Rights: VI. Maps Applicants are required to provide the following maps as part of their applications: 1. Locational map - A United States Geographical Survey topographic map showing the boundaries of the farmland tract. (available from County Planning Commission or County Conservation District) 2. Tax map - Tax map(s) of the farmland tract with map reference and tax parcel numbers clearly indicated. (available from County Assessor) **3. Soils map - The soils map of the farmland tract. This must be color-coded according to the colors in use by USDA Natural Resource Conservation Service. (available from Natural Resource Conservation Service or County Conservation District) Class I Class II Class III Class IV Wetlands Green Yellow Red Blue Cross Hatch or include on separate map ** Conservation District can provide soils information

** VII. Soils Report The applicant is required to provide a soils report for the farmland tract as part of the application. This soils report must include a soils narrative for each of the soils on the farm. The applicant is also required to provide a table showing the capability class of each soil type and use of the land as part of this application (below). Township: Acres Offered: SOILS REPORT Capability Classes I-IV Capability Cropland Pasture Other Total Class Acres Acres Acres Acres I II III IV Sub Total I-IV Capability Classes V-VIII Capability Cropland Pasture Other Total Class Acres Acres Acres Acres V VI VII VIII Sub Total V-VIII TOTALS Capability Cropland Hay/Pasture Other Total Class Acres Acres Acres Acres I-IV V-VIII TOTAL

Soils Report Continued Percent of Total Acres in Land Capability Classes I-IV Step 1. Total Acres Cropland and Pasture in Soil Capability Classes I-IV divided by Total Easement Acres Step 2. x 100 = % Is percentage calculated above 50%? (yes/no) Step 3 If no, document whether 50%, or more, of the total easement acreage is both available for and of soil capability classes I-IV. Percent of Total Acres in Agricultural Use: Total Acres Cropland + Total Acres Pasture divided by Total Easement Acres = x 100 = %

VIII. Selling Price I would consider selling an Agricultural Conservation Easement to the Clinton County Agricultural Land Preservation Board and/or the Commonwealth of Pennsylvania for not less than: 1. $ for the entire farm, or 2. $ per acre, or 3. an amount to be determined by appraisal and acceptable to buyer and seller. 4. acres offered for easement. VII. Signature(s) It is necessary for all owners of the farmland tract to give their approval and consent to this application. Signed: Date: If the County Board and applicant agree that an appraisal will be performed by the Board, the applicant will be required to submit a written request for an appraisal and a $250.00 deposit which the County Board will hold in an escrow account. This deposit will be refunded only if: (1) The County Board does not conduct an appraisal; or (2) The County Board conducts an appraisal but does not make an offer to purchase an easement; or (3) The County Board's final offer is less than the appraised value of the easement and such offer is refused by the applicant; or (4) The applicant sells an easement to the County and/or the Commonwealth. ***PLEASE SUBMIT THIS APPLICATION AND YOUR $50.00 NON- REFUNDABLE CHECK, MADE PAYABLE TO: CLINTON COUNTY AG PRESERVATION PROGRAM. SEND TO THE: Clinton County Conservation District 45 Cooperation Lane Mill Hall, PA 17751 Deadline for Applications is March 31st, of each odd-numbered year, in order to be considered for ranking that year. Questions can be addressed to Mary Ann Bower, at 570-726-3798