SECTION 1 – Applicant Information
Landowner Name:	County:
Tract Number:	Parcel:
SECTION 2 – Verification of Attachments
Verify all attachments are provided: (to be retained in Area Office)
VDOF-Approved Forest Stewardship Management Plan	Original Date:
Latest Revised Date:
Proof of Land Ownership
Proof of Timber Value (verify Form 18.8 application value matches background documentation of the value)
Final Harvest Inspection Report	Date:
ESRI Shape File (to be imported to IFRIS)
OR	Hard Copy of USGS 7.5” Topographic Quadrangle with Buffer Boundaries (Area Forester to digitize in IFRIS)
SECTION 3 – Verification of Application for Submission
Verify the following documents are complete and accurate to be sent to the Headquarters Water Quality Program Manager along with this completed verification form:
Form 18.8 Riparian Buffer Tax Credit Application
Form 18.9 Riparian Buffer Tax Credit S-Corporation/Partnership Landowner Information (if applicable)
RBTC Application Fee of $150 (check or money order)	Check Number:
Email ESRI Shape File to Headquarters GIS (Imported to IFRIS)
OR	Printed IFRIS Map with RFB acres listed in the map comment field
SECTION 4 – Buffer Value Determination
Choose Method for Determining the Buffer Value:
Professional Timber Cruise Buffer Value	OR	Calculate Value in Buffer
$	Total Harvest Value:	$
Total Harvest Acreage:
Calculated Per Acre Value:	$
Buffer Acreage (to 1/10 acre per IFRIS mapping):
Calculated Buffer Value:	$
SECTION 5 – Tax Credit Calculation
Choose Level of Harvesting Done in the Buffer:
No Harvest	OR	Partial Harvest
(credit is 25% of the buffer value, up to $17,500)	(credit is 25% of half of the buffer value, up to $17,500)
Calculated Buffer Tax Credit:	$	Calculated Buffer Tax Credit:	$
SECTION 6 – Verified By Signature
VDOF Verifier Name (Print)	VDOF Verifier Signature	Date