BURLINGTON COUNTY FARMLAND PRESERVATION EASEMENT PURCHASE PROGRAM APPLICATION FOR CONSIDERATION PINELANDS

BURLINGTON COUNTY FARMLAND PRESERVATION EASEMENT PURCHASE PROGRAM APPLICATION FOR CONSIDERATION PINELANDS Return this form to: Farmland Preservation Program Burlington County Department of Resource Conservation P. O. Box 6000 Mt. Holly, NJ 08060-6000 If you have any questions about completing this document, please contact Farmland Preservation Program staff at the Department of Resource Conservation, (856) 642-3850. NOTE: Some questions require that your answer be provided on a separate sheet. Attach additional sheets if the space provided for answering a question is insufficient. Failure to answer all questions is grounds for rejection of the application. Use of "N/A" to answer a question is not acceptable. Use "Not Applicable" only when clearly appropriate. If you do not know the answer to a question, write "Do Not Know". State the name, address and telephone numbers of the person who should be contacted concerning this application. Please provide the requested information for the Owner of the Farmland Property: Landowner Name(s): Landowner Address: E-Mail Address: Landowner Telephone: (Day) (Fax) (Eve) Address of Farm Location: Applicant s Attorney: Attorney s Telephone: Attorney s Fax: Please provide the requested information for the person who should be contacted concerning this application or check here if the Landowner is to be the Contact. Contact Name: Contact Address: Contact E-Mail Address: (Fax) Contact Telephone: (Day) (Eve) Contact s Relationship to Landowner: Page 1 of 17 Updated 3/4/2011

Method of Valuation For applicant Farms within the Pinelands Region both valuation methods described below will be conducted by Burlington County. Once both easement values have been established and certified the County will present the offer that yields the highest compensation to the landowner. 1. Method of Valuation of Easement. N.J.A.C. 2:76-19.3 gives landowners the right to decide whether to have the development easement valued by real estate appraisers (based on such factors as current zoning, environmental constraints, etc.) or computed in accordance with the formula. Please use the formula adopted by the SADC to determine the value of the development easement on my property. NOTE: The SADC's regulations limit the value paid for the development easement as computed with the formula to not more than 80 percent of the full value of the property ( fee simple value). Accordingly, an appraisal of the property will be conducted to determine whether the value resulting from the formula exceeds 80% of the fee simple value of the property. Please hire two real estate appraisers and have them provide valuations of the development easement on my property. 2. Restrictions on Impervious Cover. Pursuant to N.J.A.C. 2:76-19.4(c), the SADC's formula provides for an increase in the value of the development easement if the owner is willing to limit impervious cover on the property to 10% of the total property acreage. "Impervious cover" means structures through which water cannot pass. The term includes, but is not limited to, that area of the property covered by houses, barns, stables, sheds, silos, and other buildings, swimming pools, docks and decks. Temporary greenhouses and other temporary coverings which do not have impervious floors are excluded from the computation of the impervious coverage area. Agreeing to the 10% impervious cover restriction increase the base value of property eligible for 2 PDCs per 39 acres from $1,600/acre to $1,800/acre and increases the base value of property eligible for 1 PDC per 39 acres from $160/acre to $180/acre. Are you agreeable to including in the deed to be recorded a restriction of impervious cover on the property to ten percent (10%) of the total property acreage? Yes No 3. Restrictions on Use in Wetlands Areas. The SADC's formula gives owners an option of applying additional deed restrictions related to lake, reservoir or stream areas in order to increase the base value. The owner has the option of including or not including the following restriction in the deed to be recorded: Agricultural use of wetlands and areas within 300 feet of wetlands ("wetlands transition areas") shall be consistent with subchapter 6 of the Pinelands Comprehensive Management Plan, N.J.A.C. 7:50-6, as may be amended from time to time. Specifically, except for horticulture of native Pinelands species, berry agriculture, and beekeeping, agriculture shall not be permitted in wetlands and wetlands transition areas, except if such agricultural uses existed prior to the promulgation of the Pinelands Comprehensive Management Plan in 1979 or if the Comprehensive Management Plan is amended to permit such uses. a. Lakes & Reservoirs: If the property contains lakes and reservoirs that significantly impact the recharge of the Cohansey Aquifer, contain water year round, and are greater than two acres, the base value for the property will be increased by.375% per acre of land attributed to the lake/reservoir. The maximum adjustment achieved cannot exceed 15% of the base value of the property. b. Streams: If the property contains any streams, (not just bordered by a stream), the base value shall be increased by 20%. Page 2 of 17 Updated 3/4/2011

Please select whichever of the following that apply: I want the base value increased because there is a lake or reservoir on my property and I am willing to have the above printed restriction included in my deed. I want the base value increased because there is a stream on or bordering my property and I am willing to have the above printed restriction included in my deed. SECTION I. INFORMATION ABOUT THE PROPERTY. 1.1. Name each parcel of land from which the development easement is to be sold. List each lot separately. These parcels, together, constitute the "Property" referred to in the rest of this form. Pinelands Management Area Designation (Ag. Production, Special Block Lot # Acres (Ag. Production, or Preservation) a. b. c. d. e. f. Total: 1.2. Indicate the source of the acreage stated above: survey tax map deed tax bill other: 1.3. Does the Owner of the Property own other lands which (a) are in agricultural use and (b) are either adjacent to or within one mile of the Property? Yes No. If "yes", describe the other lands by municipality and tax map lot and block number. 1.4. Have any Pinelands Development Credits ("PDCs") been severed from the property? Yes No If "yes" please provide a copy of the deed of restrictions that was recorded when the PDCs were severed from the property. 1.5. Name all roads on which the Property has frontage: 1.6. How many acres of the Property are in cultivation? acres Provide a copy of the most recent application for farmland assessment submitted to the local tax assessor. Page 3 of 17 Updated 3/4/2011

1.7. Are any of the water bodies on the property used in the agricultural operation of the Property? Yes No If "yes" describe the use: 1.8. Is all of the Property assessed as farmland? Yes No. If "no", state which parcels are not assessed as farmland and state the real property tax classification for each (e.g., commercial, vacant, etc). 1.9. Is all of the Property in active agricultural use? For the purpose of this section "active agricultural use" means that the land is in production or is fallow as part of a program of crop rotation. Yes No. If "no" provide the following information: (a) # of acres: (b) the tax map block and lot number(s): (c) how the land is used: (d) the reason for the use: 1.10. Do you have a survey of all or any portion of the Property? Yes No If "yes" please provide a copy of it or provide the surveyor s name & date of survey: 1.11. Is the Property subject to a farmland preservation program agreement? Yes No If "Yes", state the date when the agreement was signed: 1.12. Has a wetlands delineation or assessment been made of all or any portion of the Property? Yes No If "yes" provide a copy of the delineation. 1.13. Have percolation or soil permeability tests been conducted on any portion of the Property? Yes No If "yes" state the test date(s), the number of tests and the area(s) of the Property tested. Please attach a copy of the test results: 1.14. Since the time that the current owners acquired title to the Property has any portion of it been subdivided? Yes No If "yes" provide a copy of the subdivision deed. 1.15. Is there currently pending an application to subdivide any portion of the Property? Yes No If "yes" submit with this application (a) a copy of the subdivision Page 4 of 17 Updated 3/4/2011

plan submitted for approval and (b) a copy of the subdivision application form. 1.16. Is the Property listed with a real estate broker or posted as for sale? Yes No If "yes" state the date on which the listing agreement expire: 1.17. Has sale of the Property been under negotiation within the last year? Yes No If "yes" briefly describe the negotiations and their status. 1.18. Is the Property under agreement of sale or does any person have an option to purchase? Yes No If "yes", attach a copy of the agreement to this application. 1.19. Are there any preliminary or final municipal approvals in place for development of all or a portion of the Property? Yes No If "yes" submit with this application a copy of the written letter(s) or resolution(s) which approve(s) the application. 1.20. Is any application for development of the Property currently pending? Yes No If "yes" describe the application, where it is pending and when action on the application is anticipated. 1.21. Describe all hazardous materials stored on the Property (other than materials which are applied or used as an accepted farm practice) and their use, if any. "Hazardous material" means a substance named on DEP's "Unified Hazardous Substance List". 1.22. To your knowledge has there ever been a spill of hazardous materials on the Property or has any hazardous material been buried or disposed of on the Property? Yes No If "yes," on a separate sheet please describe each incident or describe the material that is buried, the quantity buried, how deep it is buried, when it was buried, and the amount of surface acreage under which it is buried. 1.23. Has an environmental assessment been done for any portion or all of the Property? Yes No If "yes", provide a copy of the assessment report. 1.24. Has any wastewater treatment plant sludge been applied to the Property? Yes No Page 5 of 17 Updated 3/4/2011

If "yes" state (a) who applied the sludge and (b) the number of times and dates it was applied: 1.25. Has any wastewater treatment plant sludge-derived product been used as a fertilizer on the Property? Yes No If "yes" name the product, the manufacturer and the dates the product was used. 1.26. If there are fuel storage tanks on the Property complete Attachment 1 to this application. If there are no fuel storage tanks on the Property check here: 1.27. Do high-tension electrical lines cross any portion of the Property? Yes No If "yes" name the tax map block and lot number on which they are located. 1.28. Check below any of the following that apply and attach a letter to this application describing anything special about the Property: the main residence on the Property was built prior to 1920, is in good condition and inhabited or is in habitable condition. there are multiple structures on the Property that are in good condition and have historic significance. the product of the Property or farming methods is/are unique or unusual. 1.29 Do any encroachments from adjoining lots, that are not part of this application, exist on the farm (septic systems, wells)? Page 6 of 17 Updated 3/4/2011

II. OWNERSHIP AND LEGAL MATTERS 2.1. For each tax map parcel provide the name and address of all persons who have an ownership interest in the Property below. 1. Parcel Block & Lot: Name & Address: 2. Parcel Block & Lot: Name & Address: 2.2. If a person named in response to question 2.1 above has a spouse who is not also named above state the name here. Owner Name Name of Spouse a. b. c. 2.3. Report the date on which the current owners acquired title to the Property and provide a copy of the deed(s). If the owner acquired title through inheritance provide a copy of the probated will and any court order applicable to the property. Date: 2.4. If the owner is an estate, provide copies of the following: i. Complaint to admit will to probate ii. Will and order accepting will to probate iii. Any court orders pertaining to the subject property iv. Evidence of the appointment of an Executor or Administrator 2.5. If the owner or part owner of the Property is a corporation provide a copy of the corporation's charter and bylaws and name the following: i. President: ii. Chief executive officer: iii. Secretary: 2.6. If the owner or part owner is a partnership provide with this application a copy of the partnership agreement and certification of partnership. Page 7 of 17 Updated 3/4/2011

2.7. Name each person/organization (other than the persons who hold title) who has an interest that pertains use of the Property and describe their interest. A "legal interest" includes, but is not limited to, a lease, use easement, utility easement, drainage easement, access easement and right-of-way. Name: Interest: Address: Name: Interest: Address: 2.7.1. Name each entity or person that holds a mortgage on the Property: Company: Mortgage date: Address: 2.7.2. Name each entity or person that has a security interest in crops or personal property (e.g., equipment) on the Property: Company: Date acquired: Address: 2.8. Describe any pending court, arbitration, or foreclosure proceedings that concern the Property or which might have an impact on the Property. 2.9. Provide a copy of any written order, judgment, resolution or agreement resulting from any concluded court or arbitration proceeding which has an impact on use or development of the Property. 2.10. Has any person threatened to bring legal proceedings against the Property owner during the past 6 months? Yes No If "yes" attach a separate sheet describing the nature of the matter. 2.11. Do you have a title insurance policy on all or any part of the Property? Yes: all part No If "yes", please provide a copy of the policy. Page 8 of 17 Updated 3/4/2011

III. AGRICULTURAL USE OF PROPERTY 3.1. Describe the agricultural products produced on the Property over the year preceding the date of this application (e.g., Christmas trees, oats, hay, milk): 3.2. Describe all non-residential improvements that assist in or support agricultural use on the Property (e.g., barns, sheds, silos, drainage facilities, irrigation systems, etc.) 3.3. Does the farm have a farm conservation plan approved by the Burlington County Soil Conservation District? Yes No If "yes", provide a copy of the plan with this application. 3.4. Is part or all of the Property farmed by any person(s) other than the owners? If so, provide the following information: Name Address Phone # Acres Agreement is: oral written date of expiration: 3.5. Is part or all of the Property managed by any person(s) other than the owners? If so, provide the following information: Name Address Phone # Acres Agreement is: oral written date of expiration: 3.6. What long-term plans do you have for the Property? Page 9 of 17 Updated 3/4/2011

3.7. Is there a farm market on the Property? Yes No If "Yes" provide the following information: Square feet of structure: Type of structure: Acreage or square feet of market parking area: Period of operation (year round or state the months of operation): Non-agricultural products sold from market: Market is operated by owner operated by lessee Nonagricultural products sold: IV. STRUCTURES ON THE PROPERTY 4.1. For each building on the Property that has human occupants provide the information requested below. Be careful to list every residential unit. Block & Unit # of Interest of Lot #s Type* Residents Residents** a. b. c. d. *For "unit type" state: "M/H" for mobile home; "F/H" for single family farmhouse; " D" for duplex (2- dwelling unit structure); "A/L" for ag labor housing; "APT" for apartment; "O" for other ** For "interest" state: "owner" for owner and his/her immediate family; "relative(s)" for family members other than the owner; "mgmt" for the farm operator, "ag labor" or "tenant" for residential renter. 4.2. Are there written leases with the persons who rent a portion of the Property for residence? Yes: some all No 4.3. Is there any building on the Property which is suitable for human habitation but is not currently in use? Yes No If "yes" describe each briefly and state why it is not in use. Block/Lot Building Reason for nonuse 4.4. Are there any visible remnants of residential or farm buildings on the Property? Yes No If "yes" describe the Block/Lot site of the remnant(s), the number of buildings indicated by remnants and their former use (if known): Page 10 of 17 Updated 3/4/2011

V. NON-AGRICULTURAL USE OF THE PROPERTY 5.1. Describe all uses of the Property that are not related to agriculture that are now in operation on the Property (i.e. repair shop, home office, pet kennel, etc.): #1: Use description: Location: Number of acres or square feet: Date use began: Persons who engage in the use: Do you intend to continue the use? Yes No Do you intend to expand the use? Yes No. If yes, please describe your intentions for the future expansion: #2: Use description: Location: Number of acres or square feet: Date use began: Persons who engage in the use: Do you intend to continue the use? Yes No Do you intend to expand the use? Yes No If yes, please describe your intentions for the future expansion: Page 11 of 17 Updated 3/4/2011

FUTURE HOUSING OPPORTUNITIES The total maximum number of housing opportunities permitted on a farm under the Burlington County Farmland Preservation Program is generally one house per 100 acres of land. Where a property is less than 100 acres in size and no existing housing units exist, landowners may apply for a maximum of one new housing opportunity. A landowner can request the opportunity to construct one or more housing units in the future in three ways: request a Residual Dwelling Site Opportunity (RDSO), request that an area be excluded from the easement (an Exception ), or request that a portion of the farm be subdivided from the land to be excluded from the farmland preservation program (a Subdivision ). Each of these options is described in greater detail below. However, under the Pinelands Easement Purchase Program, a landowner must retain ¼ Pinelands Development Credit (PDC) for each future housing opportunity to be achieved. As such, it is important that you indicate how many PDCs you are requesting be retained to provide for these future housing opportunities. FUTURE NON-AGRICULTURAL USES Notwithstanding Pinelands or local municipal ordinance regulations, once the deed restriction is placed on the property, no non-agricultural uses of the property or the buildings thereon will be permitted. This includes uses such as antique shops, bed & breakfasts, grain sales, etc. Therefore, if you have any intention of instituting such uses in the future, areas to be dedicated to such uses must be identified at the time of application. Upon approval of the County, areas can be reserved from the easement restrictions for such uses through creation of an exception or subdivision as described above. It is generally recommended that landowners consider creating an exception around existing houses and outbuildings to provide flexibility in use of those structures in the future. Also, if you have or intend to initiate a farm market on the property, it is recommended that you create an exception around the area dedicated or to be dedicated to that use. Since the area contained in exceptions and subdivisions are not subject to the deed of easement restrictions, landowners are not paid for the acreage contained therein. However, excepted or subdivided areas of the property would be subject to minor restrictions in order to protect the area of the property to remain in agricultural use. VI. EXCLUSIONS FROM EASEMENT RESTRICTIONS (Exceptions and Subdivisions) 6.1. This application is for the purpose of permanently restricting all of the Property to agricultural use. If the applicant wants to exclude any portion of the Property from the deed of easement restrictions County approval must be obtained. Two options are available: (a) the owner may apply to subdivide a portion of the Property and submits a copy of the subdivision application to the County or (b) a small portion of the Property is exempted from the area subject to the easement restrictions, but remains part of the existing tax map parcel (an exception). 6.2. Neither an owner's proposal to subdivide acreage or to have a portion of the Property excluded from the standard restrictions will be granted if the County determines that the subdivision or exclusion (exception) would adversely affect the agricultural operation or if the County sees no public benefit from preserving the balance of the Property. 6.3. If the County approves subdivision of land from the Property, the applicant is required to bear all costs to secure municipal and County planning board approval of the subdivision. The County will Page 12 of 17 Updated 3/4/2011

specify a deadline for the owner to submit evidence of municipal and county planning board approval of the subdivision. 6.4. If the County agrees to exclude a portion of the Property from the standard restrictions to be imposed by the deed of easement, certain conditions to that approval will be imposed. At a minimum, use of the excepted area may not hinder, impinge upon or adversely affect the deed-restricted portion of the Property. Excluded areas may not be subdivided or sold separately. If the exception is for the purpose of constructing a residential structure only one dwelling unit will be permitted. 6.5. The location of the portion of the Property to be excluded from the standard easement terms must be established prior to the time the County hires a surveyor to survey the Property. 6.6. If you wish to (a) subdivide a portion of the Property for the purpose of excluding it from this application or (b) exclude any portion of the Property from the standard deed of easement restrictions state the number of acres you want excluded and submit with this application form a copy of the tax map sheet on which you have indicated its approximate location, size, and shape. a. Number of acres you wish to subdivide: b. Number of acres you wish to exclude : Reason for (proposed use of) the requested subdivision or exclusion: c. Number of PDCs you wish to retain for future housing opportunities: VII. RESIDUAL DWELLING SITE OPPORTUNITIES (RDSOs) 7.1. Applicants may request the award of one or more Residual Dwelling Site Opportunities (called RDSOs). An RDSO is the opportunity (not an unconditional right) to construct a residential unit and related structures after the Property has been restricted by deed to agricultural use. If the request for an RDSO is granted, the total amount payable for the purchase of the development easement will be reduced in accordance with State policies and regulations. For each RDSO granted, the total payment will be reduced by four times the per-acre easement value. 7.2. A minimum land area of at least 100 acres is required for each RDSO; however, decisions on requests for RDSOs will take into account the number of existing residential buildings on the Property and the physical characteristics of the Property. a. State the number of RDSOs (if any) you are requesting: b. Number of PDCs you wish to retain for future housing opportunities: VIII. COUNTY POLICIES CONCERNING PAYMENT FOR EASEMENT PURCHASES 8.1. The County has adopted a policy for the method by which it pays for farmland preservation easement purchases. That policy is described in a two-page form being provided with this application. IX. TERMS AND CONDITIONS OF THIS APPLICATION 9.1. The Property owner is responsible for obtaining from all persons holding a mortgage or lien against the Property written approval of the owner's application to sell a development easement and Page 13 of 17 Updated 3/4/2011

commitment to subordinate the mortgage or lien to the deed of easement. The owner is responsible for filing the Lienholder Notification/Information Form at the time of application and the Lienholder Commitment Form at time of contract with the County. Failure to file all approvals within the time specified by the County may result in rejection of the application. Special procedures may apply in cases when lienholder approval is denied. 9.2. If your application is accepted, you may not expand the scope of any nonagricultural use that is being made of the Property at the time the application is submitted to the County. "Expansion" of a nonagricultural use includes, but is not limited, to: using more acreage on the Property, increasing the intensity of the use, or starting a new nonagricultural use. 9.3. Development of all or any part of the Property for non-agricultural use or changes to the Property which impact on the agricultural use of the Property (e.g., removal of topsoil) during the time that this application is pending may result in disqualification of the application. In addition, the Property owner(s) agree to pay the County for the costs incurred in assessing any wetlands on the Property and appraising the value of the development easement if the application is disqualified for this reason. 9.4. The County reserves the right to except from the deed of easement portions of the Property which it believes should not be restricted to agricultural use. These exclusions include existing and proposed road rights-of-way and projected improvements to county, state and municipal roads and highways, existing or proposed drainage facilities and land needed for the construction of facilities for improvements to roadway intersections and bridges. 9.5. If the County has accepted an application consisting of multiple tax map parcels that the applicant wants considered together the owner may not sell less than all of the tax map parcels during the time that the application is pending. This prohibition continues in effect until a contract for the sale of the development easement closes. Once the Property is subject to the easement an owner's proposal to sell less than all of the parcels requires County approval. X. APPLICANT COMMITMENTS, ACKNOWLEDGMENTS AND AUTHORIZATIONS 10.1. Applicants understand that this application may be disqualified in the event that it is found that an applicant has willfully provided false information. If the application is disqualified for this reason after the County has incurred wetlands or appraisal costs the applicants shall be liable to pay the County the costs incurred. 10.2. All persons signing this application agree to cooperate in the review of this application and to provide such additional information and documents which the County deems necessary. Submission of this application shall authorize the County Agriculture Development Board, the State Agriculture Development Committee, the State Transfer of Development Rights Bank and their servants, agents and contractors (including consultants conducting a wetlands assessment, septic analysis and real estate appraisers) to come onto the Property during regular business hours on reasonable prior notice at any time while the application is pending. Failure of the applicants to give access to the Property shall constitute grounds for disqualification of the application and the assessment of costs incurred by the County against the applicants. 10.3. Because the purpose of the program is to permanently restrict your Property to agricultural use, the County recommends that you consult with an attorney with respect to how this restriction could affect you. In addition, you may be liable to the County for damages if you violate the terms and conditions of this application. The Burlington County Bar Association has a lawyer referral service that can provide you with names of attorneys who might assist you. The Bar Association telephone number is (609) 261-4862. Applicants' signatures to this application constitute an acknowledgment Page 14 of 17 Updated 3/4/2011

that they have been advised that they have the right to consult with an attorney with respect to this matter. 10.4. The purpose of this program is to preserve, conserve and protect agricultural lands. The owners hereby covenant and agree that they will continue the Property in agricultural use during the time that this application is pending for a maximum of nine months. The owners acknowledge that they will be responsible for the County's costs to obtain a wetlands assessment and two appraisals of the Property in the event that the Property is sold for other than agricultural use or is put to nonagricultural use prior to the time that an easement value is established for the Property. 10.5. The applicants hereby covenant and agree that any sale of the Property during the time that the application is pending shall be made subject to this application and the purchaser shall be substituted for the applicant. In the event that the purchaser of the Property declines to proceed with the application the applicant shall be responsible for and agrees to pay the County the costs incurred to assess the wetlands and appraise the Property. 10.6. If the sale of the development rights/development easement on this Property does not occur because of the owner's dissatisfaction with the purchase price offered by the County, the Property owner(s) will be ineligible to apply to this program for this Property for a period of two years. 10.7. The proposed deed of easement form is included in the information packet. The actual form of the deed which will be used for this program may be different, but is not expected to be significantly different. 10.8. Applicant(s)'s signature(s) on this application shall authorize the Burlington County Agriculture Development Board, the Burlington County Board of Chosen Freeholders, State Agriculture Development Committee and State Transfer of Development Rights Bank to review, investigate, process and consider this application. Page 15 of 17 Updated 3/4/2011

Check the applicable BURLINGTON COUNTY FARMLAND PRESERVATION PROGRAM PINELANDS EASEMENT PURCHASE PROGRAM APPLICATION FOR THE SALE OF A DEVELOPMENT EASEMENT Owner is: an estate a business partnership a corporation multiple unrelated persons husband & wife multiple related persons single person All current owners of the Property must sign below. If the owner or part owner of the Property is a corporation, a corporate resolution authorizing submission of this application and its execution by a corporate officer or the corporation's attorney must be attached. If the owner or part owner of the Property is a partnership, all partners must sign below. If an Estate owns the Property, the documents referred to in Section 3.4 must be provided with the application and each co-executor or co-administrator must sign below. * * * * * I (we), the person(s) who has (have) signed below, certify that the information provided in this application is true. I (We) understand that if any of the information provided in or with this application is false and known by me (us) to be false, the County of Burlington shall have the right to reject this application and I (we) agree that I (we) shall be responsible for the costs incurred by the County in processing this application if the property identified herein is selected for purchase. I (we) agree to comply with the terms and conditions as described in the application. I (we) acknowledge that I (we) have had the opportunity to review the deed of easement form prescribed by the State. I (we) agree that I (we) shall have no right to withdraw this application because of any objection to the language of that document. This application is binding on me (us) and on my (our) heirs, successors, administrators, representatives and assigns. Name (typed or printed) Signature Date Checklist for a Complete Application: ALL questions in the application and attachment have been answered. ALL documents that the application requires to be provided are enclosed with the Application. ALL of the property's owners have signed this form. Page 16 of 17 Updated 3/4/2011

BURLINGTON COUNTY FARMLAND PRESERVATION PROGRAM PINELANDS EASEMENT PURCHASE PROGRAM APPLICATION FOR THE SALE OF A DEVELOPMENT EASEMENT ATTACHMENT 1 - FUEL STORAGE TANKS ON THE PROPERTY Provide the information requested below for each tank. Underground tanks: Size (capacity) Contents Purpose a. b. c. d. e. f. Above-ground storage tanks: Size (capacity) Contents Purpose a. b. c. d. Page 17 of 17 Updated 3/4/2011