Roxbury, NY · Delaware County
Agricultural Data Statement
This statement is completed by applicants seeking certain municipal approvals for projects near farm operations in an Agricultural District.
What this form is
Applicants complete this statement for subdivision approval, a special use permit, site plan approval, or a use variance when a project is within 500 feet of a farm operation in an Agricultural District. It asks for applicant and owner contact details, project and tax map information, farming activity, and nearby farm operations. The applicant must send project notices to those operations by certified mail and present proof of mailing to the Municipal Review Board.
Who needs it
Applicants seeking a listed municipal approval for a project within 500 feet of a farm operation in an Agricultural District complete this statement.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed without a notary; the applicant and owner sign and the applicant dates the statement.
How to submit this form
- 1
Download The Statement
Download the Agricultural Data Statement PDF.
- 2
Complete Part I
Enter applicant and owner details, project information, tax map numbers, and details about nearby farm operations.
- 3
Send Required Notices
Send project notices to the listed farm operations by certified mail and keep proof of mailing.
- 4
Submit The Statement
Submit it to the city department named on the form and present proof of mailing to the Municipal Review Board.
Frequently asked questions
- Do I need a notary for the Agricultural Data Statement?
- No. The form has signature lines for the applicant and owner, but no notary block. The signer just signs and dates it.
- Who completes the Agricultural Data Statement?
- The applicant completes Part I for certain municipal approval applications involving a project within 500 feet of a farm operation in an Agricultural District.
- What information does the statement ask for?
- It requests applicant and owner contact details, project and tax map information, whether the parcel is farmed, and details about nearby farm operations.
- How do I submit the Agricultural Data Statement?
- Submit it to the city department named on the form; check the city website for current contact details. The form also says proof of certified-mail notices must be presented to the Municipal Review Board.
Need something notarized?
This Agricultural Data Statement doesn’t need a notary — but if you have another Roxbury form that does, a commissioned online notary can help.