WAYNE COUNTY VOLUNTARY AGRICULTURAL DISTRICTS

MEMBERSHIP APPLICATION

 

APPLICANT INFORMATION:

 

Name:__________________________________________________________________________________________

 

Address:________________________________________________________________________________________

 

City:__________________________________ State:_________________ Zip Code:__________________________

 

Home Phone No.:______________________ Work Phone No.:_________________________

 

Mobile No.____________________________ Fax No.:_______________________________

 

PROPERTY INFORMATION:

 

Property Location/Address:________________________________________________________________________

 

Parcel No.:  _________________________   Number of Acres:_________________

 

 

Additional Tracts:

 

Street/Road Address:  _____________________________________________________________________________

Township: _________________________                 Tax Map/Parcel No.:_____________________Acres________________

FSA Farm No.______________________  Owners:_____________________________________________________

 

Street/Road Address:  _____________________________________________________________________________

Township: _________________________                 Tax Map/Parcel No.:_____________________Acres________________

FSA Farm No.______________________  Owners:_____________________________________________________

 

Street/Road Address:  _____________________________________________________________________________

Township: _________________________                 Tax Map/Parcel No.:_____________________Acres________________

FSA Farm No.______________________  Owners:_____________________________________________________

 

OWNER(S) CERTIFICATION:

 

I (We), the applicant(s), hereby certify that, to the best of my (our) ability, the foregoing application is complete and accurate. I also certify that I am the proprietor or have the authority to designate farmland into the Voluntary Agricultural District.

 

Signature of Owners/Applicant:___________________________________________  Date:___________________

 

                                                           ___________________________________________  Date:___________________

 

 

 

Application should be accompanied with a $50.00 check made payable to County of Wayne.

 

 

Mail To:                Voluntary Agricultural Districts

                                PO Box 68

                                Goldsboro, NC 27533-0068