Section I. Requestor's Information Name of Requestor*
First
Last
Requestor's Affiliation* (select one) Attorney for Conservation Restriction Holder Consultant for Conservation Restriction Holder Conservation Restriction Holder Family Member of Conservation Restriction Holder Other (explain below)
Requestor's Mailing Address*
Additional Contact Information If additional persons are assisting with this request, please list their contact information below.
Section II. Conservation Restriction Holder's Information Is the Conservation Restriction Holder the Requestor?* Name(s) of Conservation Restriction Holder(s)* Please list two names here if the restriction is held by co-holders residing at the same address. Use the fields below for other co-holders.
First
Last
Name(s) of Conservation Restriction Holder 2
First
Last
Conservation Restriction Holder(s) Mailing Address*
Is there a co-holder of the conservation restriction?* Name(s) of Conservation Restriction Co-Holder(s) Please list two names here if the restriction is co-held by co-holders residing at the same address. Use the field below for other co-holders.
First
Last
Name
First
Last
Conservation Restriction Co-Holder(s) Address
Additional Holder(s) If more than two persons or entities hold the conservation restriction, please list their contact information here.
Section III. Property Information For the property on which the conservation restriction that is the subject of this release request is located, please provide the following information. If the restriction encompasses more than one tax lot in the same municipality, please list all blocks and lots under Location #1. If the restriction is located in more than one municipality, please provide this information under Location #2. If the restriction covers property located in more than two municipalities, please provide additional location information in the box at the end of this section.
Location County* (select one) Atlantic Bergen Burlington Camden Cape May Cumberland Essex Gloucester Hudson Hunterdon Mercer Middlesex Monmouth Morris Ocean Passaic Salem Somerset Sussex Union Warren
Is the property located in more than one municipality?*
Location #2 County (select one) Atlantic Bergen Burlington Camden Cape May Cumberland Essex Gloucester Hudson Hunterdon Mercer Middlesex Monmouth Morris Ocean Passaic Salem Somerset Sussex Union Warren
Additional Locations If the restriction applies to property located in more than two municipalities, list additional location information here.
Maps Aerial Maps Please upload aerial map(s) depicting the property on which the conservation restriction is located, and the area to be released.
Survey If survey(s) of the property on which the conservation restriction is located are available, please upload them here.
Section IV. Conservation Restriction Information Conservation Restriction Document Upload a copy of the deed or other instrument that created the conservation restriction, including any amendments to the conservation restriction.
By what method was the conservation restriction created?*
For Conservation Restrictions Created as a Condition of a Permit, Regulatory Approval or Subdivision Approval Permit, Regulatory Approval or Subdivision Approval Documents Upload a copy of any permit, regulatory approval or subdivision approval that required the creation of the conservation restriction.
Related Permit or Approval Documents Upload a copy of any permit, regulatory approval or subdivision approval issued by a State agency, a regional planning entity, a municipality or county for the project for which the creation of the conservation restriction was required. For example, if the creation of the conservation restriction was required by a municipal subdivision approval, but the project also required a DEP permit or a Pinelands Commission or Highlands Council approval, please attach those related approvals here.
Has the entity that required the conservation restriction been notified about this release request?* Has the entity that required the conservation restriction approved this release request?* Note: If the entity that required the conservation restriction has not yet approved this release request, you may be required to obtain that approval before the NJDEP takes action on this release request.
Correspondence/Approvals Related to Release Request Describe any discussions you have had about the proposed release with the entity that required the conservation restriction to be created. If you do not believe this entity has jurisdiction over the release request, please explain. If an approval by the entity that required the creation of the conservation restriction is pending, please explain any remaining procedural requirements and provide an anticipated approval date.
Correspondence/Approvals Related to Release Request Upload any relevant correspondence with the entity that required the conservation restriction to be created, including any approvals for the proposed release issued by that entity.
For Conservation Restrictions Created by Purchase or Charitable Donation Was the conservation restriction purchased or acquired by charitable donation?* Was the conservation restriction purchased with restricted funds?* Examples of restricted funds include Green Acres funds, municipal or County open space tax funds, and restricted grant funds.
Has the funding entity or charitable donor been notified about this release request?* Has the funding entity or charitable donor approved this release request?* Note: If the entity that required the conservation restriction has not yet approved this release request, you may be required to obtain that approval before the NJDEP takes action on this release request.
Correspondence with/Approvals by the Funding Entity or Charitable Donor Describe any discussions you have had about the proposed release with the funding entity or charitable donor for the conservation restriction. If you do not believe the funding entity or charitable donor has jurisdiction over the requested release, please explain. If the approval of the funding entity or charitable donor is pending, please explain any remaining procedural requirements and provide an anticipated approval date.
Correspondence/Approvals Related to Release Request Upload any relevant correspondence with the funding entity or charitable donor for the conservation restriction, including any approvals for the proposed release issued by the funding entity or charitable donor.
For Conservation Restrictions Donated as a Condition of an Order or Settlement Agreement in an Administrative or Judicial Proceeding Administrative or Judicial Order or Settlement Document Upload a copy of the administrative or judicial order or settlement agreement that required the conservation restriction to be donated.
Have the other parties to the administrative or judicial proceeding been notified about this release request?* Have the other parties to the administrative or judicial proceeding approved this release request?* Note: If the entity that required the conservation restriction has not yet approved this release request, you may be required to obtain that approval before the NJDEP takes action on this release request.
Correspondence with/Approvals by the Parties to the Administrative or Judicial Proceeding Describe any discussions you have had about the proposed release with the other parties to the administrative or judicial proceeding. If you believe the other parties to the administrative or judicial proceeding are not required to be consulted about or do not have jurisdiction over the requested release, please explain. If the approval of the other parties to the administrative or judicial proceeding is pending, please explain any remaining procedural requirements and provide an anticipated approval date.
Correspondence/Approvals Related to Release Request Upload any relevant correspondence with the the other parties to the administrative or judicial order or settlement agreement that required the conservation restriction to be donated, including any approvals for the proposed release issued by the other parties or the administrative or judicial entity.
Section V. Description of Release Request and Justification Describe the Release Request*
Related Documents If the release request is related to a permit, regulatory approval, subdivision approval or order or settlement agreement in an administrative or judicial proceeding, attach the relevant documents, and any relevant correspondence, here.
Consideration for Release* If any consideration, compensation or mitigation is proposed for the release, describe here and attach any relevant documents.
Related Documents Attach any relevant correspondence or documents related to the proposed consideration, compensation or mitigation for this release request.
Public Interest Analysis* Under N.J.S.A. 13:8B-6, in reviewing this release request, the DEP Commissioner is required to take into consideration the public interest in preserving the restricted lands in their natural state, and any State, local or regional program in furtherance thereof. Please explain how the requested release would be consistent with, or not contradict, this criterion and attach any relevant documents. Be specific in citing to and analyzing any relevant programs that affect the property; general statements about consistency are not acceptable.
Related Documents Attach any relevant correspondence or documents that support a conclusion that the proposed release does not contradict the public interest in preserving the restricted lands in their natural state, and any State, local or regional program in furtherance thereof.
Planning Analysis* Under N.J.S.A. 13:8B-6, in reviewing this release request, the DEP Commissioner is required to take into consideration any State, regional or local comprehensive land use or development plan affecting the property on which the conservation restriction is located. Please explain how the requested release would either be consistent with, or not contradict, this criterion and attach any relevant documents. Be specific in citing to and analyzing any relevant plans that affect the property; general statements about consistency are not acceptable.
Related Documents Attach any relevant correspondence or documents that support a conclusion that the proposed release does not conflict with, or supports, any State, regional or local comprehensive land use or development plan affecting the property on which the conservation restriction is located.
Section VI. Public Hearing Has the public hearing required by N.J.S.A. 13:8B-5 been conducted?* Proof of Publication of Newspaper Notices Required by N.J.S.A. 13:8B-5 Note: Under N.J.S.A. 13:8B-5, notice of the public hearing is required to be published in a newspaper of general circulation in the municipality in which the restricted property is located, twice a week for the three weeks preceding the hearing (for a total of six notices). Please attach proof of publication for all six notices.
Minutes/Transcript of Public Hearing
If "no", please explain when and where the public hearing is anticipated to occur and upload a draft public hearing notice Note: If the public hearing required by N.J.S.A. 13:8B-5 has not been conducted before this request is submitted, please consult OTPLA before scheduling the public hearing.
Draft Public Hearing Notice
Section VII. Additional Information Additional Information Please list and/or upload any additional information you want the Department to take into consideration as part of this request.
Section VIII. Attachments Please check the boxes next to all documents that have been uploaded as part of this request.
Untitled If "Other", list any additional documents attached to this request
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