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U.S. Department of Agriculture <br />Natural Resources Conservation Service <br />NRCS-CPA-41A <br />12/2016 <br />b) Yes ❑ No ❑ Do you have appropriate documents including proof to sign for the entity? <br />4. The land offeredF under this parcel sheet is (select one): <br />✓❑ Private Land <br />❑ Tribal, Allotted, Ceded, or Indian Land <br />5. Is the land being offered for enrollment (select all that apply): <br />❑✓ Cropland ❑ Rangeland ❑✓ Pastureland <br />❑ Grassland or land that contains forbs <br />❑ Shrubland for which grazing is the predominant use <br />❑ Located in an area that has been historically dominated by grass land, forbs, or shrubs <br />and could provide habitat for animal or plant populations of significant ecological value <br />❑ Nonindustrial private forest land that contributes to the economic viability of an offered <br />parcel or serves as a buffer to p rotect such land from development. <br />Identify percent: <br />6. ❑✓ Yes ❑ No Is this parcel subject to a written pending offer'" signed by the eligible entity <br />for purchase of an agricultural land easementF by an eligible entry? <br />Attach the pending offer for purchase of an agricultural land easement to this parcel sheet. <br />7. ❑ Yes ❑1 No Is any portion of the parcel subject to an easement or deed restriction which <br />provides similar protection as would be provided by enrollment in ACEP-ALE? <br />8. ❑ Yes [0 No Is there any portion of the Parcel where the purposes of ACEP would be <br />undermined due to on-site or offsite conditions, such as risk of hazardous substances, <br />proposed or existing rights of way, infrastructure development, or adjacent land uses? <br />9. ❑a Yes ❑No Is the entire parcel accessible from a public road or is there an insurable, <br />.unconditional and transferable legal right of recorded access for the tern of the <br />easement? <br />Attach map showing access from a public road or evidence of insurable, unconditional, and <br />transferable legal right of recorded access. <br />10. Complete the table below for this parcel: <br />These values may be estimates, subject to the Final values being determined by an NRCS-approved <br />appraisal report. <br />A. Estimated Fair Market Value of this ALE $ 1,875, 00.00 <br />B. Estimated Entity Non -Federal Cash Contribution to $937,500.00 <br />this ALE excluding Landowner donation <br />C. Requested Federal Share for this ALE $ 937,600.00 <br />D. Estimated Purchase PrlceF of this ALE (D = B + C) $1875,000.00 <br />E. Estimated Landowner Donation for this ALS (E = A — ) $ 0.00 <br />11. Do the landowners of this parcel meet the criteria for any of the following categories? Check all <br />that apply. Please note that providing this information is voluntary and will not be used when reviewing <br />this application or determining whether the landowners meet the ACEP Landowner eligibility <br />requirements. This information may be used when considering an Entity request for a waiver of the Entity <br />cash contribution requirement for a project of special signfcance as defined in 7 CFR § 1468.24(b)(4). <br />❑ Limited -Resource Farmer or Rancher""' <br />[]Beginning Farmer or Rancher" <br />