Date:
SECTION 1 – Landowner Information
Landowner Name:
Last Name	First Name
Landowner Objectives:
SECTION 2 – Discussion Topics	(to be discussed during interview)
Conservation Easement:	[Date Discussed]	Potential Landowner Expenses:	[Date Discussed]
What is it?	Attorney ($3,000-$5,000)
Descendants’ Needs/Expectations	Appraisal ($2,500-$10,000)
Future Owners	Title Insurance (40% of Easement Value: $250-500)
Easement Value Calculation	Survey (if boundary line disputes, uncertainties)
Financial Benefits (handout/brochure)	FSMP (VDOF Rates)
Local Taxes (Land Use)	Conservation Service Providers
Federal Deduction	Donation Process: (provide copy to Landowner)	[Date Discussed]
State Land Conservation Tax Credits	Compliance with Government Plans
Estate Tax Reduction	County Comprehensive Plan
VDOF Easement Program:	[Date Discussed]	Appropriate Zoning
Purpose/Criteria	VDOT 6-Year Plan
Conservation Values (describe for this property)	Utilities
Retained Rights	Any Issues?	[Date Discussed]
Divisions (caution on future local zoning changes)	Reserved Mineral Rights
Primary/Secondary Residences	Property Lines
Other Structures	Liens
Commercial Uses	Environmental Concerns/Hazards
Farming & Forestry, Processing & Sales	(Hazardous Wastes, etc.)
Businesses Inside Buildings	Other:	[Date Discussed]
Small-scale Power Generation	Voluntary (Landowner Can Back Out Any Time)
Ecosystem Services	Disclaimer
Restrictions	(VDOF Cannot Provide Legal or Financial Advice)
Forest Conservation Limits	Landowner Needs to Retain Legal & Financial Counsel
FSMP by First Monitoring Visit
BMPs	Request Copy of Plat or Survey
Riparian Buffers	Provide Landowner with Referrals
Surface Disturbance, Mining, Drilling, Borrow Pits	Other Available Potential Conservation Tools
Accumulation of Trash
Signs on the Property
Additional Requirements for >$1MM Credits
SECTION 3 – Signature
Interviewer Name (Print)	Interviewer Signature	Date