Application Number:
SECTION 1 – Applicant Information
Logger Name:
Note: In order to process this application, a Taxpayer ID Number is required. Therefore, please complete a State W-9 (Request for Taxpayer Identification Number and Certification) and return it with your application.
Logger NAID Number:	SHARP Logger ID:
Property Location:	Tract Number:	Parcel:
Latitude:	Longitude:
Note: Attach a tract map highlighting the entire acreage to be harvested (IFRIS PDF file preferred).
Parcel Description:	Stand Age:	Pine Species:
SECTION 2 – Harvest Description
Total Acres to be Thinned:
Initial Stocking:	trees per acre	OR	sq. ft per acre
Target Stocking Following Thinning:	trees per acre	OR	sq. ft per acre
Description of Harvest Plan:
SECTION 3 – Logger Agreement
I request funding under the Pine Bark Beetle Prevention – Logger Incentive Cost-Share Program for the indicated harvest project. I agree:
Each application is for ONE parcel and that assistance shall be 100% of itemized logging costs, not to exceed $4,000 per parcel for conducting a first commercial thinning that meets the following requirements: Parcel must be 5 – 30 acres in size. Parcel must be between 12 and 22 years of age. Parcel must have a minimum basal area of 110 sq. ft. per acre or 350 trees per acre. Parcel must be thinned to a target of 60 – 80 sq. ft. per acre or 100 – 250 trees per acres of live, healthy, undamaged volume. Parcel must be non-industrial, private use only. This also excludes property owned by Real Estate Investment Trusts (REITs) and Timber Investment Management Organizations (TIMOs).	To provide Form 3.9 Forestry Cost-Share or Grant Program Certification of Work Completed as an itemized statement of cost. That I may not receive more than $12,000 per federal fiscal year (10/01-09/30) per tax identification entity. I am a certified SHARP Logger (or equivalent if not in Virginia). I do not currently owe the Virginia Department of Forestry any civil penalties or other outstanding debt. Failure to meet any of the standards described will result in forfeiture of these cost-share funds.
Logger Name (Print)	Logger Signature	Date
SECTION 4 – DOF Approvals
I certify that the above project is needed and, if properly carried out according to the above recommendations, will qualify for incentive payment under the Pine Bark Beetle Prevention – Logger Incentive Cost-Share Program.
Forester Name (Print)	Forester Signature	Date
Forest Health Budget Manager Name (Print)	Forest Health Budget Manager Signature	Date
I certify that the above project was completed according to the above recommendations.
Final Project Cost:	Final Cost-Share Amount:
(See Form 3.9, attached)
Forester Name (Print)	Forester Signature	Date
DOF Headquarters Office/Finance Use Only
Cost Code:	Amount:	Approved for Payment: