September 2019 Loudoun County Conservation Easement Assistance Program Application

2. This application must be filled out by a land trust on behalf of the property owner. Applications submitted by owners will not be considered.

   This application must be filled out by a land trust on behalf of the property owner. Applications submitted by owners will not be considered.

4. Applicant Land Trust Information

6. Name*

8. Address*

9. Phone*

11. Website*

12. Federal Tax ID #*

16. Land Trust Contact Person

18. Name*

19. Title*

21. Phone*

22. Email Address*

26. Property Owner(s) Information

28. Name(s)*

30. Phone*

31. Email Address*

35. Real Property to be Placed Under Conservation Easement
    Please provide copy of deed and survey in attachments.

    Please provide copy of deed and survey in attachments.

37. PIN*

38. Address

40. Instrument where property acquired

41. Legal Acreage

45. 1. Will the total number of legal acres be placed under conservation easement?*

    1. Yes
    2. No

47. If "no," please explain and indicate the number of acres to be placed under conservation easement.

49. 2. Is the property owner’s gross household income less than or equal to the 100% Area Median Income of Loudoun County (currently $121,300)? *

    1. Yes
    2. No

    If the answer is no, the property owners do not qualify.

51. 3. Is the property entirely located in Loudoun County?*

    1. Yes
    2. No

53. If no, is more than 50 percent of the property located within Loudoun County?

    1. Yes
    2. No

    If the answer is "no," the land does not qualify.

55. Please provide the following information:

    1. Approximate percentage of property within Loudoun. 2. Name of other locality. 3. Parcel number in other locality.

57. 4. Is the property capable of being subdivided?*

    1. Yes
    2. No

59. If yes, please provide details:

61. If no, is the property in the Agricultural & Forestal District Program?

    1. Yes
    2. No

    (If the answer is "no," the land does not qualify.)

63. 5. Have the restrictions that will be imposed by the conservation easement been fully explained to the property owner? *

    1. Yes
    2. No

65. 6. Is the property currently under conservation easement or otherwise restricted from development?*

    1. Yes
    2. No

67. If no, is the property under Land Use or in the Agricultural and Forestal District program?

    1. Yes
    2. No

    (If the answer is "no," the land does not qualify)

69. 7. Does the property have documented historic and/or cultural resources or attributes?*

    1. Yes
    2. No

71. If "yes," please list and describe.

73. 8. How much grant award funding is being requested? *

    Funding is one half of the upfront costs (attorney’s fees, land appraisal and survey fees, processing and document fees, and stewardship costs) or $15,000, whichever is less.

75. 9. Does the property contain sensitive or unique natural resources, such as watersheds, habitat, or geological features or land with Prime Agricultural Soils or Soils of Statewide Importance, as defined by the Natural Resources Conservation Service (NRCS) soil survey?

    1. Yes
    2. No

77. If "yes," please list and describe.

79. Please attach the following to the application (all three must be attached for grant to be considered): *

    1. 1. Copy of deed and survey
    2. 2. Proof of meeting income requirements (affidavit form provided by Loudoun County)
    3. 3. Official estimates for qualifying upfront services covered by grant: attorney’s fees, land appraisal and survey fees, processing and document fees, and stewardship costs

81. Upload files here

83. Acknowledgement*

    hereby acknowledges and agree that all information submitted on the application is accurate and truthful to the best of our knowledge.

85. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree
87. Electronic Signature*

89. 1. Does the proposed use of the property as permanent open space conform to the Comprehensive Plan?

    1. Yes
    2. No (if no, the land does not qualify)

91. 2. How many development rights are relinquished with a conservation easement on this property?

Leave This Blank:


93. 1. Receive an email copy of this form.
94. Email address

    This field is not part of the form submission.

95. Submit

* indicates a required field