This section to be completed by all applicants. Please fill out the following information for the owner or authorized representative of the entity that owns the property.

Provide the following information for each parcel of land you wish to enroll. (If you fail to provide the required information, including number of eligible acres for each parcel, your application will be delayed or denied.

By signing below, I certify that this form is correct and complete to the best of my knowledge, I am an owner of the property or an authorized member, partner, or shareholder of the entity that owns the property for which Rural Preserve is being claimed, and I understand the consequences that will result if I terminate my enrollment, or no longer qualify for enrollment in the Rural Preserve Program which are explained in the instructions for this form.