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County of Rockland |
Nomination Form
All nomination forms should be returned to: C. Scott Vanderhoef, County Executive, Allison-Parris County Office Building, 11 New Hempstead Road, New City, New York 10956
I. Nominator Information:
Nominator’s Name: _________________________________________________________________
Nominator’s Address: _________________________________________________________________
_________________________________________________________________
Nominator’s Phone #: _________________________________________________________________
II. Property Owner Information:
Property Owner or Legal Representative (If different from nominee): _________________________________________________________________
Property Owner’s Address: _________________________________________________________________
_________________________________________________________________
Property Owner’s Phone #: _________________________________________________________________
III. General Site Information:
Address of Property: _________________________________________________________________
_________________________________________________________________
Town: ___________________________ Village: _________________________
School District: ____________________________________________________
Tax Map #: _____________________________________ Block: ____________
Lot: ______________
Acreage: _______________________________ Zoning District: _____________
What was the property used for in the past?
___________________________________________________________Are there any structures located on the proposed property? Yes - No - Unknown
If Yes, How many and what are they used for?
_________________________________________________________
Are there any Deed Restrictions, Covenants, or Easements, currently or proposed, affecting this property? Yes - No - Unknown
If Yes, Please describe all restrictions:
____________________________________________________________Are there any Known or Suspected Hazardous Waste Deposits located on this Property?
Yes - No - Unknown
If Yes, Please explain:
____________________________________________________________Is the property you are nominating in immediate threat of development?
Yes - No - Unknown
If Yes, Explain:
____________________________________________________________Is the proposed property currently tax delinquent?
Yes - No - UnknownIs the nominated property identified for protection by a Rockland County Department of Planning document or in another municipal, state, interstate or federal agency’s report?
Yes – No - Unknown
If yes, please specify:
___________________________________________________________
IV. Acquisition Criteria:
The following section will be used by the County of Rockland to determine which properties should be given the highest priority for acquisition and thereby preservation. Please check all criteria that apply to the nominated property.
The property you are nominating connects with other protected open spaces.
Explain __________________________________________________________________________
The property protects environmentally sensitive resources.
Explain __________________________________________________________________________
The property is a farm or used for farming.
Explain ___________________________________________________________________________
The property has historic or cultural significance.
Explain ___________________________________________________________________________
The nominated property is located on the shore of the Hudson River or it provides the opportunity to connect with the Hudson River.
Explain ___________________________________________________________________________
The property will be available as the result of redevelopment.
Explain ___________________________________________________________________________
The property’s natural features provide a special opportunity for recreational use.
Explain ___________________________________________________________________________
The property will help in protecting a river or stream.
Explain ___________________________________________________________________________
The property is part of a watershed area.
Explain ___________________________________________________________________________
Please include any other reasons why this proposed property should be included in this program:
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
V. Financial Information:
Are there any mortgages or liens on this property? Yes – No - Unknown
If Yes, Please list and explain all mortgages and liens against this property, please include
the original amount and approximate balance: ___________________________________________________________________________
___________________________________________________________________________
Is this property currently for sale? Yes – No - Unknown
If Yes, What is the current asking price for this property?
___________________________________________________________________________
VI. Additional Information Required:
Photos: Include 4 X 6 photos showing the overall property and any structures that exist on site.
Map: Submit a tax a map with subject property highlighted.
Narrative: Submit a one-page narrative detailing project acquisition describing why you feel property needs to be protected.