ADD NEW PARCELS TO MY COALITION MEMBERSHIP

Coalition Member Name: Click here to enter text. Coalition Membership Number: Click here to enter text.

Assessor Parcel Number (APN) / Parcel Acres / Irrigated Acres / Agriculture Commissioners Restricted Materials Permit Number
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  1. Fill out this section if you are the landowner and farm the property.
  2. Fill out this section if you are the landowner that will be paying the Coalition fees and lease the property to others to farm.

Assessor Parcel Number (APN) / Parcel Acres / Irrigated Acres / Lessee Name / Lessee Mailing Address / Lessee Phone Number / Lessee Email Address
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  1. Fill out this section if you lease property that you farm and pay the Coalition fees for the leased acres.

Assessor Parcel Number (APN) / Parcel Acres / Irrigated Acres / Assessee/Landowner Name / Assessee/Landowner Mailing Address / Assessee/Landowner Phone Number / Agriculture Commissioners Restricted Materials permit number
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☐ “I certify I have provided written notice to the lessee(s) or operator(s) or Landowner of the enrolled properties in the Coalition under this order and have notified them of the order.”

Total New Parcel Acres Added to Membership Click here to enter text.x $5.50 =$Click here to enter text.