lorpt_short_frm_2012_portrait.pdf

2012 Landowner Report -Short Form

CONFIDENTIAL REPORT OF TIMBER HARVEST

pursuant to 12MRSA c805, sub-c 5.

printed under appropriation # 010-04A-5420-512-4929

Department of Agriculture, Conservation and Forestry, Maine Forest Service 22 State House Station, Augusta, Maine 04333 (207) 287-2791 or in-state 1-800-367-0223

This REPORT is for the NOTIFICATION NUMBER listed at left only. Do not combine information for more than one notification on this report.

WHO COMPLETES THIS FORM? Landowners (or their designated agent) who filed a Forest Operations Notification form for harvesting during calendar year 2012.

This information is required under authority of 12 MRSA, Chapter 805, sub-Chapter 5.

NEED ASSISTANCE? For more information or assistance with this form, contact the Maine For-est Service at (207) 287-2791, in-state 1-800-367-0223, or email forestinfo@maine.gov.

If you did not harvest in 2012, just answer the questions in Section A, Certification; sign in Section C, & re-turn. Then you are finished!

Name:

Address:

City:

State: Zip:

Notification #:

Harvest Town:

County:

READ ENCLOSED INSTRUCTIONS FIRST

Mail no later than January 31, 2013 to Maine Forest Service,22 State House Station, Augusta, ME 04333.

C. Signature:

I hereby certify that the information contained herein is accurate and complete to the best of my knowledge.

SIGNATURE (Landowner or designated agent): _________________________________ Date: _____

My daytime phone #: (___)___________________ Reports without signatures will be returned.

B. Method of Payment or Type of Sale:

(Check the appropriate one below and complete the sections of this form.)

Landowner did not cut the trees but received payment for them. Complete all sections of this re-port.

Landowner cut the trees. Complete all sections of this report.

There was a harvest, but no wood was sold. Complete all sections of this report.

Other ______________________________ Complete all sections of this report.

A. Certification: [check Yes or No] Please answer both questions below.

1. My property was harvested during calendar year 2012. Yes No

2. This harvest is complete. Please close out this notification. Yes No

Acreage Class Total forestland acres you own in Maine

1-100 acres

101-1,000 acres

1,001-100,000 acres

100,001+ acres

Ownership Type

Forest Industry Land

Institutional Investor Timberlands

Non-Industrial Land (Private woodlot)

Other Forest Land (Govt, etc.)

Section D.

Ownership Information

Section G. Non-harvest Information Herbicide Treatments

Acres Site Preparation Acres Release

Non-commercial Thinning Acres not reported in Section E.

Acres of Non-Commercial Activities (i.e. thinning, weeding)

Tree Planting

Species of Trees Planted Acres Planted by Species

Section E. Harvest Information

DO NOT REPORT THE SAME HARVEST ACRES IN MORE

THAN ONE PLACE BELOW.

Harvest Type # of Acres Cut

Partial Cut Harvest:

Shelterwood Harvest

Initial/Intermediate:

Final/Overstory Removal:

Change of land use acres:

Land changed to:

(i.e. woodlands changed to pas-ture, houselot, etc.)

Clear-cut Harvest(s):

List all acres of individual clear-cut(s) created in spaces to the right.

Use additional paper if neces-sary to list all clearcuts.

If any of the forest products from this harvest were exported (if known) outside of Maine or sold to a broker for export, please provide the name and address of the exporter or broker:

Name & Address:

1. I have a written management plan for this property. Yes No

2. A Maine Licensed Forester managed this harvest. Yes No

Forester’s Name:

3. This forestland is certified by Forest Stew-ardship Council, Sustainable Forestry Initi-ative, American Tree Farm System, or Sci-entific Certification Systems.

Yes No

Logger’s Name (required):

Logger’s Address:

Section F. Harvest Involvement