Form Lpc-1 - Application For A Land Preservation Credit

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Application for a Land Preservation Credit
Form
*VALPC1112888*
LPC-1
Acknowledgment of receipt by the Department of Taxation of this application form does noT
Mail Form, attachments (see What to Attach)
constitute certification, approval, or validation of the donation or of the credit valuation.
and Payment (if applicable) to:
Before completing Form LPC-1, please read the instructions.
Virginia Department of Taxation
To avoid delays at the time of annual return processing, Form LPC-1 should be filed by the applicant
Tax Credit Unit
within 90 days of the donation, but at least 90 days before filing your annual return. Applications
Po Box 715
for tax credits of $1 million or more should be submitted at least 120 days before filing an annual
return.
Richmond, VA 23218-0715
For general assistance, call 804-786-2992.
Also send a copy of Form and Specified Attachments (see What To Attach) to:
For assistance regarding Sections IV, V.
Department of Conservation & Recreation, Tax Credit Program
and Schedules B & C, call 804-371-5218.
203 Governor Street, Suite 302, Richmond, VA 23219
Section I - Applicant Information
A) Entity Type - Check One
 Individual Taxpayer
 Multiple Donors
 Non-Profit  Other Entity - Specify________________
 Corporation
 Pass-Through Entity
 Trust/Estate
B) Applicant Name (As Shown on Deed)
C) Applicant Identification Number (Check appropriate box and enter number.)
 SSN
 FEIN
D) Street Address or PO Box Number
City
State
ZIP Code
E) Contact Name, If Different from Above
F) Phone Number
G) FAX Number
H) Email
Section II - Donation Questions
II-A - Questions for a Donation Made on or After January 1, 2007
A) Are you a non-profit holder of easements as defined in Va. Code § 10.1-1009?
Yes No
IF YES, Go To B; IF no, Go To C.
B) Do you hold one or more conservation easements excluding this donation that were acquired pursuant to the authority
Yes No
conferred on a “holder” by Va. Code § 10.1-1010?
IF YES, SToP. YoU Do noT QUALIFY.
C) Have you applied for a Historic Rehabilitation Credit in the last 5 years on this property/building?
Yes No
IF YES, SToP. YoU Do noT QUALIFY.
D) In the past 11 years, have you, a family member or an affiliate been issued a credit for a donation on any portion of this
Yes No
parcel(s)? IF YES, LP# _______________________ . DonATIon MAY REQUIRE DCR VERIFICATIon. (See instructions).
II-B - Questions for a Donation Made on or After July 1, 2010
A) If your application is for a credit of $250,000 or more, has a credit been applied for and/or issued within the past 3 years for
Yes
No
real property that was formerly part of the same parcel of land as the property being donated?
IF YES, LP# _______________________ . DonATIon MAY REQUIRE DCR VERIFICATIon. (See instructions).
Section III - Property and Credit Information
A) Type of Donation - Check One
B) Bargain Sale - Check One
C) Number of Acres
D) Date Acquired
 No
 Fee Simple
(If Yes, Enter Amount Received)
 Yes
 Less-Than-Fee Simple
$
.00
 Facade
E) Property Street Address (No P. O. Box)
City
State
ZIP Code
F) Property Information - Attach Additional Pages, if Needed.
Deed Book Reference
Tax Map or PIn
Locality
1.
2.
3.
4.
G) Name(s) of Eligible Conservation Agency(ies) Receiving Donation
H) Jurisdiction(s) Donation Was Recorded
I) Date Recorded
J) Appraisal Company Name
K) Company’s FEIN or SSN
L) Appraisal Evaluation Date
M) Appraised Value of Donation
N) Credit Amount Requested
O) Assessed Value Per Acre
P) Appraised Value Per Acre
Va. Dept. of Taxation LPC-1 W (Rev 10/12)

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