LeRay McAllister Pre-Application Form

1. Applicant must be one of the following

Name of Organization Applying for Funds*

Address (City, State & Zip Code)*

2. Contact Person

Contact Person's Name *

Title

E-Mail Address*

Phone Number *

Fax Number

3. Project Name*

4. Type of Funds Requested

Grant Loan

6. Total Project Cost
The amount requested can not exceed 50% of the total eligible project costs.
See list of eligible project costs. *

Requested	Secured Match	Pending Match	Not Identified	Total Costs

7. List all other sources and amounts for project funding and identify for each whether it is
secured, pending or still to be identified:

Describe the Funding Sources and Amounts Above*

8. Project Location

Principal County

Name of Municipality (or nearest)*

9. Type of Project Primarily (Check Only One)

Open Land Agricultural Land Definitions

10. What is the Present and Historical Use of the Property? *

11. Brief Project Description*

12. Preservation Method

13. Amount of Acreage to be Acquired and/or Preserved

Acreage to be acquired or restored

IMPORTANT NOTE!

A fee interest in real property may be purchased with money from the Fund ONLY IF the parcel
is no more than 20 acres in size. In counties where 50% or more of the total land mass is publicly owned,
a parcel of similar size must be contemporaneously transferred to private ownership from the
governmental entity that acquires the fee interest.

14. Who presently holds title to the property? *

15. Has the owner been contacted regarding this proposed conservation project?
Yes

Owner Agreement

16. Each interest in real property purchased with money from the Fund, whether fee title
or an easement, must be held and administered by the state, a county, a city or a town.

Proposed Easement Holder

Proposed Easement Holder Type

17. Is title to the property under cloud or dispute?

Yes No

If yes, please explain:

18. Are you aware of any other legal disputes or conflicts relating to the property or project?

Yes No

If yes, please explain:

19. Does the project have local support?
(Include city, town, county, special service districts, local legislators, others)

Please list supporters and the supporting documentation (letter, resolution, other)

20. Briefly describe intended use of funds (e.g., how much will go toward purchase
of land/easement, restoration costs, or other) *

21. Longevity of the project

How long will the land be protected *

22. Please list all partners and their interest/role with this project (e.g., organizations
who are providing financial, technical or other support)

List Organization, Contact, Title, Address, Name, Phone, Fax, Email and Interest/Role

23. Anticipated date funding is needed (e.g., date of closing/transfer of title, or other):
(mm/dd/yyyy)*

24. Has an appraisal of the property been completed?

Appraised value of property *
Describe any structures on the property

25. What is the Current Zoning of the Property? *

26. Are there any known environmental concerns?