| Contact Information |
| *Original Purchaser (entity/organization/agency): |
| *Name of person submitting report: |
| *Address: |
| *City:
*State:
*Zipcode: |
| *Phone: |
| *Email: |
|
Legal
Citation |
*Legal citation of TF appropriation (e.g. M.L. 2005, 1st Special Session, Art.1, Sec. 2, Subd. XX):
In addition, for Habitat Corridors indicate work program section --
easements (3a, 3b, 3c, etc) and/or acquisition (4a, 4b, 4c, etc) and
for Metro Corridors acquisitions indicate work program section (3.1,
3.2, 3.3, etc). |
| Acquisition Details |
| *Purchase Date(mm/dd/yyyy): |
*Working Title(s) of this Acquisition:
(if more than one title is used by partners, provide the other
working titles. e.g. Miles property, Vermillion view property.)
|
| *Type of Purchase (check appropriate box):FeeConservation EasementNone |
| Location:
|
*County:
City:
Township:
|
Range:
Section:
¼ Section:
¼ ¼ Section:
|
Please specify a file:
If more than one file, provide a single zip file.
|
| *Size in acres (provide total acres to the nearest one tenth acre): |
| Natural Resource
Conservation Values in Acres
(e.g. wetland/upland, prairie/grassland, forested, other)
:
|
Describe Adjacency to
Public/Private Conservation
Lands:
|
| Name of
Adjacent Body of Water
(if applicable):
|
Amount of
Shoreline (linear feet/miles):
|
| Funding |
| Purchase
Price: $
|
Appraised
Value: $
|
| Related
Professional Service Costs: $
|
Total
Project Costs: $
|
| Source of Money
|
Amount of Funds ($)
|
% of Total Project
Costs
|
Proportional
Size (acres)
|
| Environment & Natural
Resources Trust Fund
|
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| Other State Money
|
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| Federal Money
|
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Regional/Local Government Money
|
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| Non-profit Money
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Bargain Sale/Donation Value |
| |
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| Other Money
|
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| Total Funds
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Parcel Status
Who owns interest in parcel? Check
the appropriate option.
|
a. Interest is retained by original purchaser
b. Interest in the property was simultaneously
transfered to another entity as part of the original purchase
arrangements.
c. Interest in the property was transferred to another entity on
(mm/dd/yyyy)
|
Check appropriate option(s)
for who owns and
manages the property as of the date of this report.
Fill in contact information below. |
DNR, Wildlife Management Area - Name of WMA
DNR, Scientific and Natural Area - Name of SNA
DNR, Aquatic Management Area - Name of AMA
DNR, State Park - Name of State Park
DNR, Forestry - Name of Forestry Unit
DNR, Trails & Waterways - Name of trail or access
U.S. Fish and Wildlife Service
Local Unit of Government, specify what county or city and unit name
Other, specify what county or city and unit name
Primary Contact #1
*Name:
*Address:
*City:
*Zipcode:
*Phone:
*Email:
Primary Contact #2
Name:
Address:
City:
State:
Zipcode:
Phone:
Email:
|
| Other
Information |
| Notes/Comments:
|