Virginia Application for a Land Preservation Credit

Application for a Land Preservation Credit
Form LPC-1 - Application for a Land Preservation Credit
Form LPC-1

Application for a Land Preservation Credit

*VALPC1123888*

For land or interest in land conveyed before January 1, 2020, a complete Form LPC-1 must be filed on or before
December 31 of the 3rd year following the calendar year of the conveyance. For land or interest in land conveyed on
or after January 1, 2020, a complete Form LPC-1 must be filed on or before December 31 of the 2nd year following
the calendar year of the conveyance.
•	
Acknowledgment of receipt by the Department of Taxation of this application form does NOT constitute certification,
approval, or validation of the donation or of the credit valuation.
•	
Before completing Form LPC-1, please read the instructions.
•	
To avoid delays at the time of annual return processing, Form LPC-1 should be filed by the applicant within 90 days of the
donation, but at least 90 days before filing your annual return. Applications for tax credits of $1 million or more should be
submitted at least 120 days before filing an annual return.
For general assistance, call (804) 786-2992.
For assistance regarding Sections IV, V, and Schedules B & C, call (804) 371-5218.
Also send a copy of this form and specified enclosures (see What To Enclose) to:
Department of Conservation & Recreation, Tax Credit Program, 600 East Main Street, 24th Floor, Richmond, VA 23219

Mail form, enclosures, and payment
(if applicable) to:
Virginia Department of Taxation
Tax Credit Unit
P.O. Box 715
Richmond, VA 23218-0715

Section I – Applicant Information
A)	 Applicant Type - Check One

	
	

  Individual Taxpayer	
  Corporation 	

  Married Donors	
 Non-Profit	

  Multiple Donors	
 Trust/Estate	
  Pass-Through Entities
  Other Entity - Specify__________________________________________

B) Applicant Name (As Shown on Deed)

C) Applicant Identification Number (Check appropriate box and enter number.)

  SSN
 FEIN
D) Street Address or P.O. Box Number

City

E) Contact Name, If Different from Above

F) Phone Number

State

G) Fax Number

ZIP Code

H) Email Address

Section II – Donation Questions
II-A – Questions for a Donation Made on or After January 1, 2007
A)	 Are you a nonprofit holder of easements as defined in Va. Code § 10.1-1009?
	
IF YES, GO TO B; IF NO, GO TO C.
B)	 Do you hold one or more conservation easements excluding this donation that were acquired pursuant to the authority
conferred on a “holder” by Va. Code § 10.1-1010?
	 	 IF YES, STOP. YOU DO NOT QUALIFY.
C)	 Have you applied for a Historic Rehabilitation Credit in the last 5 years on this property/building?
	 	 IF YES, STOP. YOU DO NOT QUALIFY.
D)	 In the past 11 years, have you, a family member or an affiliate been issued a credit for a donation on any portion of this
parcel(s)? IF YES, LP# _______________________ . DONATION MAY REQUIRE DCR VERIFICATION. (See instructions).

 Yes	

 No

 Yes	

 No

 Yes	

 No

 Yes	

 No

 Yes	

 No

II-B – Questions for a Donation Made on or After July 1, 2010
A)	 If your application is for a credit of $250,000 or more, has a credit been applied for and/or issued within the past 3 years for
real property that was formerly part of the same parcel of land as the property being donated?
	

IF YES, LP# _______________________ . DONATION MAY REQUIRE DCR VERIFICATION. (See instructions).

Section III – Property and Credit Information
A)  Type of Donation - Check One

	
	
	

Fee Simple
Less-Than-Fee Simple
Facade

B)  Bargain Sale - Check One

$	

E)  Property Street Address (No P.O. Box)

F)

C)  Number of Acres

D)  Date Acquired

No
Yes (If Yes, Enter Amount Received)

.00
City

State

ZIP Code

Property Information - Enclose Additional Pages, if Needed

Zoning & Highest and Best Use

Tax Map or PIN

Recording Locality

Va. Dept. of Taxation  4901038-W   Rev. 01/23

Current Zoning:

Highest and Best Use Before Donation:

G)  Name(s) of Eligible Conservation Agency(ies) Receiving Donation

H)  Jurisdiction(s) Donation Was Recorded

I)  Date Recorded

J)  Appraisal Company Name

K)  Company’s FEIN or SSN

M)  Appraisal Report Date

N)  Appraised Value of Donation

O)  Credit Amount Requested

L)  Appraisal Evaluation Date

P)  Assessed Value of Land Per Acre

Q)  Appraised Value Per Acre

Application for a Land Preservation Credit

Form LPC-1
Page 2

*VALPC1223888*

Section IV – Conservation Information for Reporting Purposes
A) Conservation Purpose: Identify the conservation purpose(s) protected by the donation by checking the applicable box(es). Also, specify the acreage
of each use indicated. See Instructions for definitions of these conservation purpose categories.
Conservation Purpose

Check Applicable Boxes

Acres

1.	Agricultural Use
2.	Forestal Use
3.	Natural Habitat and Biological Diversity
4.	Historic Preservation
5.	Natural Resource Based Outdoor Recreation and Education
6.	Watershed Preservation
7.	Preservation of Scenic Open Space
8.	Conservation and Open Space Lands Designated by Local Governments
B) Public Benefit: Indicate how the donation will protect the conservation purpose(s) identified above and benefit the public.
Indicate which of the following restrictions are included in the deed of donation:
1.	Limitations on the number of property divisions.
2.	Limitations on the amount of new buildings and
structures.
3.	Restrictions on the location of permitted new
buildings and structures.

No

4.	Restrictions on the location of permitted
new roads or access ways.

Yes

No

Yes

No

5.	Limitations on alterations, demolition,
and ground disturbing activity that
may impact historic, cultural, or natural
heritage resources.

Yes

No

Yes

No

6.	Limitations on utility placement.

Yes

No

Yes

7.	 Please list any other restrictions specifically donated to protect the conservation purposes and to benefit the public.

Forested/Vegetated:___________________ feet
C) Riparian Buffers: If riparian buffers are required in the deed of easement, then indicate the total length
(in linear feet) of those that provide at least a 35-foot wide buffer (See instructions for definitions). No-plow:___________________________ feet
D) Land Currently Being Used for Production Agriculture and Silviculture.

Acres

1.	Provide an estimate of the number of acres of the land currently being used in production agriculture (See instructions
for definition):
2.	Provide an estimate of the number of acres of the land currently being used in production silviculture (See instructions
for definition):
E) Onsite Operational Water Quality Best Management Practices.
Does the land have onsite operational best management practices that are designed to reduce the amount of nutrients
Yes
No
and sediment entering public waters?
If Yes, indicate which of the following BMPs are being practiced, and whether the terms of the deed of easement require their continued practice.
Agriculture Best Management Practice

Currently Practiced

Deed Requires Continued Practice

Currently Practiced

Deed Requires Continued Practice

1.	 Nutrient Management Plan Writing and Implementation
2.	 Cover Crop Practices
3.	 Livestock Exclusion Practices
4.	 Riparian Buffer Practices
Silviculture Best Management Practice
5.	 Streamside Management Zones
6.	 Forest Roads
7.	 Stream Crossings
8.	 Harvest Planning
9.	 Other Agriculture or Silviculture BMPs (See instructions for Section D).
Provide appropriate practice number(s):
F) Forest Management: Is the property fully or partially forested? 	
If Yes, is a forest management plan included in the terms of the donation?	

Yes
Yes

No
No

Form LPC-1
Page 3

Application for a Land Preservation Credit

*VALPC1323888*

Section V – Fee Simple Donation
Check Applicable Boxes
A)	The donation is a full or partial gift in fee simple to a public or private conservation agency. (If the application
is for $1 million or more, also complete Schedule C.)
	 Conservation Agency Name: __________________________________________________
B) The donation is a full or partial gift to a “holder” as defined in Va. Code § 10.1-1009, and documentation is
included that the agency agrees that subsequent conveyances of the fee interest in the property will be made subject
to a conservation easement or will be made to the Commonwealth of Virginia or a federal conservation agency.
	

Conservation Agency Name: __________________________________________________

Section VI – Less-Than-Fee Simple Donation
Explain how this donation meets the requirements of § 170(h) of the United States Internal Revenue Code of 1986, as amended.
Enclose additional pages if needed.

Section VII – Declaration, Signature, and Notarization
Enclosure Checklist
DCR - All Donations (2007 & After)	

TAX - All Donations

A Copy of LPC Application

  Original LPC Application

IRS Form 8283

  Recorded Deed

Recorded Deed

  A Copy or CD of Full Appraisal

DCR - Donations of $1 Million or More (2007 & After)

  IRS Form 8283

Baseline Documentation

  Signed Statement or Affidavit from Appraiser
Baseline Documentation

I (we) the undersigned declare, under the penalties provided by law, that this form (including any accompanying schedules, statements, and
enclosures) has been examined by me (us) and is, to the best of my (our) knowledge and belief, a true, correct, and complete application, made
in good faith pursuant to the income tax laws of the Commonwealth of Virginia. I (we) understand that the Department of Taxation will record the
information submitted on this application; however, acceptance of this application does not constitute certification, approval, or validation of the
donation or valuation of the credit by the Department of Taxation. If a person other than the taxpayer prepares this application, their declaration is
based on all information of which they have knowledge.
I authorize the Department of Taxation to discuss my application with the contact person listed in Section I of Schedule A, my broker,
and share and/or discuss this application with DCR, if applicable. Further, I authorize the Department of Conservation and Recreation to
discuss my application with the contact person, the holder of the conservation easement, or the holder’s representative, if applicable.

Must Be
Signed in
Presence
of Notary

Signature of Applicant

Signature of Applicant

Print Name

Print Name

Title

Date

Title

Date

Notary Information
Subscribed and sworn before me this ___________day of ____________________________,
20 _____ , in the (City/County) ____________________________, of _________________________.
Notary Public Signature

Date

Notary Public Name Printed

My Commission Expires