Washtenaw County, Michigan





Landowner:                                                                              Evening Phone:


Address:                                                                                   Daytime Phone:


City & Zip:                                                                               Email:




Property address (if different from above):


Parcel ID Number(s):




Number of acres:                         Acres nominated:                     In agriculture production:



I own the nominated property by                                              Deed                 Land Contract


If a land contract, the sellerís signature is required in the certification section.

Are there any liens and encumbrances on the parcel?:


            Yes                  No


If so, please list all liens and encumbrances on the property (please attached list if you can not fit them here):   


Are there any surface or subsurface leases or easements on the parcel?:

            Yes                  No


If so, please list all surface and subsurface leases or easements on the parcel (please attached list if you can not fit them here):



Are you aware of the existence of any environmental contaminants or concerns with the property?                      Yes                    No


If so, please describe:


Check one of the following:       I own all mineral rights    I own some mineral rights


I do not own any mineral rights              I do not know who owns the mineral rights



Is the property certified by the Michigan Agricultural Environmental Assurance Program?                      

Yes                  No


Is there a conservation plan developed by the Natural Resources Conservation Service or other pertinent agency for the property?                   Yes                    No              Donít Know


Please describe other conservation practices employed on the property:


Please describe the agricultural use carried out on the property and other current uses of the property:



Is the property enrolled in a P.A. 116 Farmland and Open Space Agreement (FDRA)?

Yes                  No


Are there unique historical or architectural features on the property, or is it a Centennial Farm?  

Yes                  No                                         


If so, please describe:


Do you know of any presence of water bodies, scenic views, streams, wetlands, rare species or other features on the property?:


            Yes                  No


If so, please describe:


Is the landowner willing to accept a price for development rights lower than the appraised value?*


        Yes               No


If so, enter a percentage:


*this willingness generates points on county, state and federal scoring systems and may result in a federal income tax deduction as a charitable contribution


Please describe any future plans for this property that may affect this property in the future (this may include estate plans, plans after a death in the family, etc):









Please include a copy of a legal description for the property, a copy of the deed to the property and an aerial photograph (if available), as well as a map.  If you are excluding some land from consideration, please indicate that area on the aerial photo and/or map.  Feel free to attach photographs, reports or other depictions of the property and additional sheets of paper with descriptions of any of the questions on this application form.


I (we) hereby submit this application for the Webster Township Purchase of Development Rights  Program.  I (we) certify that the statements made above are a true and accurate representation of the facts regarding the nominated parcel(s).  I (we) understand that this submission does not commit me to selling development rights and that permission is hereby given to Webster Township, or its employees or contractors and the Webster Township Farm Land and Open Space Preservation Board, to access my property to perform necessary evaluations, such as an inspection or an appraisal, should my property be selected.




__________________________________________                        ________________________

Signature                                                                                              Date



__________________________________________                        ________________________

Signature                                                                                              Date




Send to:

Mary Dee Heller, Clerk

Webster Township                                                                  
5665 Webster Church Road                                                     (734) 426-5103

Dexter, MI 48130                                                                    (734) 426-6267 fax