Form Pt-48-5-7.7 - Forest Land Protection Assessment Applications Page 2
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4PT-48-5-7.7 (Aug 2011)
FOREST LAND CONSERVATION USE ASSESSMENT COVENANT
Section B: Questionnaire
Check Appropriate Ownership Type:
[ ] One or more individuals (includes executors, administrators and trustees)
[ ] Entity registered to do business in the State of Georgia (county tax official may request verification of registration: such verification may include
sales tax number, FEI number, etc.)
Additional Owner Signatures (if needed)
Print Name
Signature/Date
OTHER COUNTIES AND ACREAGE included in this application for FOREST LAND PROTECTION COVENANT
County Name/Application #
Property Description/Other County Parcel #/Acreage
In addition to the primary use of the property as specified in the application, specific secondary uses are permitted. Please indicate if any
of the following are applicable to the property covered by this application and the total amount of acreage used:
[ ] Promotion, preservation, or management of wildlife habitat. ______
[ ] Carbon sequestration. Is the property listed on the Georgia Carbon Sequestration Registry ( ) Yes ( ) No #: ____________
[ ] Mitigation or conservation use banking to restore or conserve wetlands and other natural resources. ______
[ ] Production or maintenance of ecosystem products and services such as, but not limited to, clean air and water. ______
( ) Yes ( ) No
Is this property or any portion thereof currently being leased? If yes, briefly explain how the property is being used by the
lessee, as well as the amount of acreage of the property leased. _
( ) Yes ( ) No
Is the property or any portion thereof currently being used for fishing purposes where admission is charged? If yes, please
•
indicate amount of acreage so used.
( ) Yes ( ) No
Is the property or any portion thereof being used for production of pine straw? If yes, indicate amount of acreage so used.
( ) Yes ( ) No
Is there a residence on the property? If yes, provide the street address.
( ) Yes ( ) No
Are there other real property improvements located on this property? If yes, briefly list and describe these real property
improvements on a separate sheet and attach to this application.
( ) Yes ( ) No
Is there any type of business operated on this property? If yes, indicate business name, type of business, and amount of acreage
so used.
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