This document will become a public record and is accessible under the Freedom of Information Act (FOIA).
**IMPORTANT APPLICATION INFORMATION** By completing this form, you are applying for the Forest Legacy Program in Virginia (the “program”), a land conservation program funded by the USDA Forest Service, and administered in Virginia by the Virginia Department of Forestry (DOF). Interested persons or organizations should review the Request for Proposals document (provided separately) for details of the program. Landowners should complete this application and provide it to a Project Advocate as soon as possible so the Project Advocate can research property information to prepare a project proposal and create a GIS map for statewide project ranking. Contact DOF if you need assistance in locating a Project Advocate.
SECTION 1 – Legal Owner Information
(List all legal owners of record.)
Legal Owner Name:
Mailing Address:
Email:
Phone Number(s):
Legal Owner Name:
Mailing Address:
Email:
Phone Number(s):
Legal Owner Name:
Mailing Address:
Email:
Phone Number(s):
Legal Owner Name:
Mailing Address:
Email:
Phone Number(s):
(Attach additional pages if necessary.)
SECTION 2 – Owner-Designated Project Advocate
(Attach additional pages if necessary.) The Project Advocate is a non-profit land conservation organization (typically a land trust), state agency or other entity experienced in land conservation work that will produce a competitive project proposal and GIS map for submission to the statewide ranking process. In conjunction with DOF, the Advocate will also prepare your project proposal for national ranking should it be selected.
Name of Your Chosen Project Advocate:
Does your Project Advocate have authority to make decisions on your behalf?	Yes	No
SECTION 3 – Property Information
U.S. House District Where Property is Located:	County:
Tax Map Parcel Number(s):
Deed Reference Book/Page:
Plat Reference Book/Page:
Current Local Zoning Where Property is Located:
Tax Parcel Acreage:
Acres Offered for Forest Legacy:
Forested Acres:	Cleared/Open Land Acres:
Note: Area offered for Forest Legacy must be at least 75% forested. Planting of trees on open land to meet this requirement is acceptable.
SECTION 4 – Property Details
(Insert information or attach additional pages.)
Describe your long-term goals and objectives for the property:
Describe what have been the traditional users of the forestland on your property:
SECTION 5 – Cost-Share (Match) Commitment
Program guidelines require a 25% match for either: 1) an individual ownership if that ownership makes up the entire project, or 2) multiple ownerships that are combined into one joint project. Joint projects are proposed if the Project Advocate is able to combine different ownerships, with varying match amounts, into a multi-property proposal. Talk with the Project Advocate you have chosen to determine what type of proposal they are considering for your property. Single-Ownership Proposals – If your ownership is being offered individually, the minimum match of 25% is required. However, if you are able/willing to forego a greater percentage than this required minimum for your property, the project has the potential to be ranked higher at the national level. The amount that you match may be considered to be a donation for tax benefits (check with your tax advisor on this matter). Multiple-Ownership Proposals – If the Project Advocate is offering your property as part of a joint project (this is not as common) you have the option of offering a lesser or greater percent match for your property so long as the Advocate has other properties to combine with yours to meet the required 25% match.
SECTION 6 – Match Designation
Taking the above information into account, please designate below the percentage of the value you are willing/able to forego, as match for the program:
%
SECTION 7 – Confirmation of Understanding
Please initial each statement below to indicate that you have read and understand them:
I am willing to sell a conservation easement over my property to the Commonwealth of Virginia if a program grant is made for the purchase and I find the amount offered to buy the easement to be acceptable.
Once a program grant is made to purchase the easement, I will be notified of the amount granted in a non-binding letter of intent. I will be asked to sign this letter to state my intention to proceed with the deed negotiations for the transaction. This letter is required by the DOF before program funds can be used to pay for necessary due diligence tasks.
The program requires that an appraisal of the easement be undertaken to determine its fair market value. This appraisal must conform to Federal Yellow Book (UASFLA) appraisal standards. I will be expected to provide property information (plats, maps, legal description, etc.) in my possession, or readily available, to the appraiser that is hired by the DOF.

I will be notified in writing by the DOF of the appraised value of the easement once the appraisal is completed. This correspondence will provide information on the amount I can expect to receive to purchase the easement. I am under no obligation to sell an easement over my property for the amount offered.
While it is not common, I may be asked to pay for some of the due diligence costs for the acquisition of the easement (including the survey) or allow these costs to be deducted from the amount I am offered for the purchase of the easement. This is dependent upon the amount of program administrative funds that are available during contracting for the due diligence.
I may be asked to pay for a survey if I offer an area of my property for the easement that is less than an entire tax parcel (or multiple entire tax parcels).
If I intend to apply for Virginia Land Preservation Tax Credits or claim federal tax benefits, I will need to hire for a separate appraisal than the Yellow Book appraisal noted above.
A few weeks before closing I will be asked to sign a statement that the amount of value I forego in the bargain sale may be used as the required match for the program.
After closing, a news release will be issued to the local/statewide media to promote the program; in this article, the name of my property may be mentioned, but my personal name will not be used without my express permission.
SECTION 8 – Additional Information
(Insert information or attach additional pages.)
What is the estimated value of the easement offered for the program?
How did you determine this value? (e.g., appraisal, market analysis, landowner estimate, tax assessment, etc.)
Have the mineral rights been severed (sold or leased) from the area of your property that you are offering?
Are there any conservation easements that currently protect or restrict the property?	Yes	No	If yes, explain?
List all liens and encumbrances on the property proposed for the program. (e.g., mortgages, utility easements, public or private rights-of-way or easements, water flow or use restrictions or easements, deed restrictions, tax liens, mineral leases, etc.)
Check items that you have obtained for the property that may show it is ready to be placed under easement:
Recent market analysis, pre-appraisal, or appraisal
Agreement with potential easement holder on terms of the easement
Signed option or sales agreement with the potential easement holder
Title search
Minerals determination if mineral rights have been severed
Forest Management Plan (Stewardship Plan)
Other (describe):
SECTION 9 – Landowner Consent Agreement
I, as the landowner, agree to allow inspection of my property offered for consideration herein under the Forest Legacy Program. I agree to allow employees of the DOF or members of the Forest Legacy Subcommittee to inspect the property as may be required during the application process with the understanding that the contact person specified below shall be notified in advance of all inspection visits. Should the Forest Legacy Program grant funds for the acquisition of the easement, I agree to allow contractors hired by the DOF to enter the property to perform necessary due diligence tasks if the contact person is provided contractor contact information in advance, and the contact person is notified in advance of the expected date of the visit(s) to the property.
Primary Contact Name:
E-mail:
Phone Number(s):
SECTION 10 – Landowner Signatures
(All titleholders must sign.) The information provided in this application is true to the best of my knowledge and belief. I agree that the Project Advocate designated herein may propose a conservation easement to encumber my land for funding consideration under the Forest Legacy Program.
Landowner Name (Print)	Landowner Signature	Date
Landowner Name (Print)	Landowner Signature	Date
Landowner Name (Print)	Landowner Signature	Date
Landowner Name (Print)	Landowner Signature	Date
(Attach additional sheets if necessary. This page should be printed, signed and the originals provided to the Project Advocate.)
SECTION 11 – Attachments
The application should include the following attachments:
Aerial Photo (can be obtained via Google Maps or through your local Farm Services Agency office)
Legal Description (if available; may be found in your deed or title insurance policy)
List of Existing Permanent Improvements on the Tract (including houses, barns, lakes, ponds, wells, roads and other structures)
Map Information (provide as much map information as is available):
Copy of road map indicating the location of the property Copy of plat or survey map of the parcel indicating the location of the tract Map identifying all dumps or waste disposal sites on the property Copy of tax map, or portion thereof, containing the parcel