Applicant (Please Print)

AppendixB

WESTVIRGINIA FOREST STEWARDSHIP PROGRAM

PLANAPPLICATION

APPLICANT (PLEASE PRINT).

Last Name:First Name:MI: StreetMailingAddress: City: State: ZipCode: Telephone- Home: Work: Cell E-mail Address: PROPERTY INFORMATION

1.County:2. PropertyLocation:

3.TopographicMapQuadrangle (name):

4.UTM’s (or Longitude/Latitude) for Property:

5.TotalPropertyAcres:6.Estimated ForestedAcres:

7.DeedBookPlatNo.:

8.Arepropertylines marked?YesNoIfnot,aretheyknown?YesNo

9.Willtheowner or representativebeavailabletoaccompanyaforester ona brief reconnaissance?YesNo

10.Does the forestlandhave roads intoandthroughit?YesNo

12.Has thepropertyowner receivedprevious forestryassistance?YesNo

Ifyes,what?

13.Haveyouever soldtimber or other forest products from your woodland?YesNo

If yes,what?

Are you interested in learning more about becoming a Tree Farmer and the associated certification? Yes_____No_____

LANDOWNER PRIORITIES(RANK FROM1TO 3–1BEINGHIGHESTPRIORITY)

Timber Management (Growingtimber products)Soil andWater Conservation

WildlifeManagementAesthetics

RecreationOther (specify)

I herebyagreetoimplement,tothebest ofmy ability,theForest StewardshipPlanpreparedformyproperty.

(Signatureof ProperlyOwner)(Date)

I have contactedthefollowing ConsultingForester/DOF LOAForestertopreparemyForestStewardshipPlan.

(Nameof ConsultingForester /DOF LOAForester)(Telephone Number)

(Company/Agency Name andMailingAddress)

OPTIONAL –Topographicmap of thepropertyif available.

MAILTHECOMPLETEDAPPLICATIONTOYOURLANDOWNERASSISTANCEFORESTERFORTHE COUNTYINWHICHYOURPROPERTYISLOCATED.SEETHEATTACHEDLISTINGFORTHISMAILING INFORMATION.

PrivacyNotice:TheWestVirginiaDivisionofForestrycollectsandprocesscertainpersonalinformationasneededforappropriateand customarybusinesspurposes.PersonalinformationmaybedisclosedtootherStateagenciesofthirdpartiesas necessaryinthe normalcourseof businessortocomplywithfederalorstatelaws,includingFreedomofInformationActrequests.Ifyouhave questionsaboutouruseofpersonal information,pleasecontactusat304-558-2788. Revised6/16

FOREST STEWARDSHIP PROGRAMPLAN APPLICATION INFORMATION

1)BeforesigningtheplanapplicationforcostshareassistanceforaStewardshipPlanyoumust selectacertifiedconsultantforestertowriteyourplan.SeethelistofCertifiedConsultant Forestersonourwebsite in West Virginia.

2)VerifywiththeselectedConsultantForesterthathe/sheiswillingtowriteyourplanwithin thetimeframe.ForestStewardshipManagementPlansmustbecompletedwithinTWELVE

(12)MONTHSOFTHEAPPROVALDATE.FailuretosubmitaConsultantForester preparedplanandthecostsharereimbursementformstotheDivisionofForestrybythedue

datewill resultin forfeitureofanyreimbursement payment.

3)DonotsignacontractwithaConsultantForestertoprepareyourplanUNTILyouhave receivedawritten approval letter from theWest VirginiaDivision ofForestry.

4)UponreceiptofthecompletedStewardshipPlanApplication,aW9Taxpayeridentification form, and a Vendor Registrationand Disclosure Statement at the Division of Forestry,

pending availablefunding,agrantwillbewrittentoyouagreeing topay 75% of the approvedcostofyourForestStewardshipManagementPlan.Theapprovedrateusedforthe ForestStewardshipManagementPlanisasfollows:$600.00forCostofPlanplus$6.50per forested acre. Non forested acres will not becost shared.

Examplefor 10 ForestedAcres

Formula:$600.00 +($6.50 x 10acres) =$665.00

New Plan

Examplefor 100 ForestedAcres

Formula:$600.00 +($6.50 x 100acres) =$1250.00

New Plan

Landowner PaysConsultant / $1250.00
State ReimbursesLandowner / $937.50 (75%)
FinalLandowner Expense / $312.50 (25%)

PrivateConsultant Forestersmaychargemorethan theapproved rate. However, landowner reimbursements will not exceed theapproved acreagerate. Anyadditional Consultant Forester Fees will betheresponsibilityofthelandowner.

Upon approval oftheplantheDivision ofForestrywill notify you byletter with acopyto your Consultant Foresterofthequalifyingacresapproved for payment.

WEST VIRGINIA DIVISION OF FORESTRY

LANDOWNER ASSISTANCEFORESTERS

Forester / County / Address &Phone Number
Brent Lyons / Hancock,Brooke,Ohio,Marshall, Wetzel / USDAService Center
1BallPark Drive McMechen,WV 26040
304-238-1029
JuergenWildman / Marion, Barbour, Harrison,
Taylor, Tucker / PO Box40
Farmington,WV 26571
304-825-6983
AndyDick / Monongalia,Preston / PO Box6125
Morgantown,WV 26506
304-293-0055
JimBowen / Hardy,Pendleton,Grant,Mineral, Berkeley, Jefferson, Morgan, Hampshire / 60B IndustrialPark Road
Moorefield,WV 26506
304-538-2397
William“Craig” Okes / Mercer,Summers, Upshur, Lewis, Fayette, Braxton, Clay, Webster, Nicholas, Greenbrier, Monroe, Raleigh, McDowell, Wyoming / Court HouseAnnex
120 Ballenger St. Suite 207
Hinton,WV25951
304-466-2799
John Rossell
/ Pocahontas, Randolph / 300B Second Ave
Marlinton, WV 24954
304-799-6151
Charles Copeland / Pleasants,Tyler, Wirt, Boone, Kanawha, Logan, Lincoln, Mingo, Wayne, Ritchie, Doddridge, Gilmer, Roane, Calhoun, Wood / PO Box2/25 Schoolview St.
Elizabeth,WV 26143
304-275-0261
LarrySix
/ Mason,Putnam,Cabell.
Jackson / 624ForestryDrive
West Columbia,WV 25287 304-675-6626

VENDOR REGISTRATIONINSTRUCTIONS

First down load the most current form, obtained via this link:

Responses arerequired in all sections of the WV1A, unless otherwisenoted

Section 1:Enterlandownername,address,andtelephonenumberontheappropriate lines. (FaxNumberis optional)

Section 2:Check ‘Individual’unless another classification is more appropriate.

Section 3:Entersocialsecuritynumber(secondrow)unlessthelandownerhasan FEINnumber (first row).

Section 4: Check appropriatebox, if applicable.

Section 5: Check appropriatebox.

Section 6: Check appropriatebox.

Section 7:Check appropriatebox.(Optional)

Section 8:Check appropriateboxand fill out information ifneeded.

Section 9:Enterlandownername,position(‘Owner’ispermissible),andcityand stateof residenceon theappropriatelines.

Section 10:Initial appropriately

Section 11:List thenameofthelandowner’s bank and bank phonenumber.

Section 12:Enter N/Aunless otherwise appropriate.

Section 13:Check appropriatebox.

Thelandownermustsign name, list title, anddate theform (Page 5)

You will also need to submit a current W-9 form, obtained via this link:

Rev. 08/16

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