Spreadsheet: 20bddffa-38c8-4ab4-a472-e6722e57ee79
Sheet: Parcel Application

Farm and Ranch Land Protection Program (FRPP)
Landowner - Parcel Application
Participant Name |  |  |  |  |  | Entity
Date: |  |  |  |  |  | County
This application is to be submitted with the WV-300-25 (Rev. 11/2011)
1 | Entity or Entities Associated with the Parcel:
2 | Name(s) of the landowners of the parcel as stated in the deed: (All names on the deed must become [NAME])
3 | If a partnership or corporation, names of all partners or shareholders.  Power of attorney or authorized agent if needed. (please attach)
4 | Physical Address of the parcel: (required for Phase I) |  |  |  |  | Mailing Address of landowner(s):
5 | Legal Description of the parcel.  (Attach copy of deed, deeds or will) |  |  |  |  | Deed Book(s)
 |  |  |  |  |  | Page Number(s)
 |  |  |  |  |  | Tax Map
 |  |  |  |  |  | Parcel Number
6 | [NAME] of the parcel in acres offered for easement. |  |  |  |  |  |  | Notes
 |  | Easement (Including Exhibit B & D) |  |  |  | 0 | Acres
 |  | Residential Dwelling (Exhibit B) |  |  |  | 0 | Acres | 2 ac max per & subject to easement
 |  | Retained Development (Exhibit D) |  |  |  | 0 | Acres | 2 ac max per & subject to easement
 |  | Locally Funded Only Area |  |  |  | 0 | Acres | Not funded by NRCS contribution
 |  |  |  |  |  |  |  | Not subject to the easement
 |  | Donated Area |  |  |  | 0 | Acres | Not funded by NRCS contribution
 |  | Exception Area |  |  |  | 0 | Acres | Will be subdivided prior to closing - not funded.
 |  | Area offered to NRCS |  |  |  |  | Acres | NRCS Easement
 |  | Total Area of Easement |  |  |  |  | Acres
 |  | Total Farm Size |  |  |  |  | Acres
7 | FSA and NRCS Forms, including: Conservation Program Application (NRCS-CPA-1200); Payment Eligibility Form (Form CCC-526); Highly Erodible Land (Form AD-1026); Freedom of Information Forms; and AGI Certification (Form specific for year) |  |  |  |  | Please complete these at the local FSA service center for Farm Bill Program eligibility.
 |  |  |  |  |  | Update AGI each year enrolled in program.
8 | Maps of the parcel showing the proposed NRCS easement area. |  |  |  |  | Attach legible color aerial photo, tax map and soil map with table identifying the prime/unique/statewide/locally important soils.
9 | Acres of the prime, unique, or Statewide and locally important soil in the proposed NRCS area. (Attach soils map and table) |  |  |  |  |  | Prime: |  | 0 | Acres
 |  |  |  |  |  |  | Unique: |  | 0 | Acres
 |  |  |  |  |  |  | Statewide: |  | 0 | Acres
 |  |  |  |  |  |  | Locally Important: |  | 0 | Acres
 |  |  |  |  |  |  | Total: |  |  | Acres
 |  |  |  |  |  | Percent of Proposed NRCS area
 |  |  |  |  |  | **Check copies of the soils reports
10 | Analysis of proposed NRCS easement area:   Cropland, pastureland, hayland, rangeland, wetland forest, non-wetland forest, non-forested wetlands, and incidental land. |  |  |  |  | Cropland: |  |  | 0 | Acres
 |  |  |  |  |  | Pastureland: |  |  | 0 | Acres
 |  |  |  |  |  | Hayland: |  |  | 0 | Acres
 |  |  |  |  |  | Forested Wetland: |  |  | 0 | Acres
 |  |  |  |  |  | Forested (Non-Wetland): |  |  | 0 | Acres
 | Timber Management Plan Required: |  |  |  |  | Wetland (Non-Forested): |  |  | 0 | Acres
 | Forest Eligibility |  |  |  |  | Incidental land: |  |  | 0 | Acres
 |  |  |  |  |  | NRCS easement area |  |  |  | Total Acres
 |  | 40 acres | 20 per |  |  | **Total acres should match question #6
11 | Impervious surface to proposed NRCS easement area and any additional requested. |  |  |  |  | [NAME] square footage allowed (2% of easement)
 |  |  |  |  |  | Estimated current square footage |  |  |  | 0
 |  |  |  |  |  | Requested additional for future building(sq ft) |  |  |  | 0
 |  |  |  |  |  | Estimated total sq ft for easement
12 | Ownership of mineral rights for the proposed NRCS easement area, as well as any developmental or non-developmental gas leases, and intent to subordinate. (Attach copy of all leases and geologic assessment report). |  |  |  |  | Check all that apply |  |  | Yes | No
 |  |  |  |  |  | Severed mineral rights.
 |  |  |  |  |  | Will this be subordinated?
 |  |  |  |  |  | Developmental gas lease.
 |  |  |  |  |  | Will this be subordinated?
 |  |  |  |  |  | Non-developmental gas lease.
 |  |  |  |  |  | Geologic Assessment Report
13 | Historical resources proposed to be protected; a brief description of the site’s significance and documentation of the site’s listing on the Federal or State register. |  |  |  |  | Attach documentation of Federal or State historical  resources. Name(s) of sites, if none leave blank.
 | State Register
14 | Archaeological resources proposed to be protected; a brief description of the site’s significance and documentation of the site’s listing on the Federal or State register. |  |  |  |  | Attach documentation of archeological resources. Name(s) of sites, if none leave blank.
15 | Documentation on existence of rare, threatened and endangered species (plants or animals) from [NAME] and Wildlife or WV DNR. |  |  |  |  | Attach documentation of rare, threatened and endangered species. Name(s) of species, if none leave blank.
 | Rare, Threatened and Endangered Species List
16 | Existence of  year-round streams and/or springs. |  |  |  |  | Attach documentation of year-round stream(s) and/or spring(s) on the parcel. Name(s) of streams or springs, if none leave blank.
17 | Existence of cave(s) (as defined by the National Speleological Society), sinkholes and/or Karst topography. |  |  |  |  | Attach documentation of the cave(s) and indicate if named as well as sinkholes and/or Karst topography.  If none leave blank.
18 | Offer amount per acre |  |  |  |  | 0
19 | Total offer amount for easement |  |  |  |  | 0
20 | Agree to use the Model Deed of Conservation Easement |  |  |  |  | Model Deed of Conservation Easement
 | Landowner Signature |  |  |  |  |  | Date
NOTE: The purpose of this application is to supply information required under the USDA-NRCS Federal Farm and Ranchland Protection Program that is necessary for your local farmland protection board to apply on your behalf. You may not apply directly to the USDA-NRCS. This application must be returned to your local county farmland protection board. The USDA-NRCS will complete the hazardous waste review on the property prior to funding approval.