Landmark, Historic & Heritage Tree Registry Nomination Application Print & Mail the Application Date of Application 1. Type of Designation Landmark*Historic**Heritage*** *A Landmark Tree must meet one of the following requirements (please mark which) The tree(s) is/are commonly recognized as an established and familiar feature of the community, or can be confirmed as a significant part of the community’s heritage.The tree(s) was/were planted by, or as a memorial to, or associated with, a nationally, regionally, or state recognized individual, group, event, or cause, and is confirmed to be more than 50 years old. **A Historic Tree must meet the following requirement (please mark) The tree(s) was/were a direct witness to a historic event or cultural movement that was significant nationally, regionally, or within the state and can be confirmed to date to that time. ***A Heritage Tree must meet the following requirement (please mark) A Heritage Tree is a famous tree that is now dead but would have met the requirements for either Landmark Tree or Historic Tree had it still been alive. 2. Application is for a… Single TreeGroup of Trees 3. Location Address City Zip Code County GPS Coordinates (if available) Latitude Longitude 4. Historic or Landmark Narrative Attach a historic narrative that gives a factual account of the history of the tree or group of trees and the surrounding area, which gives the tree(s) its significance. Include important dates, people, events, legends, activities, etc. associated with the tree. 5. Ownership of Tree (If organization, corporation, government, or non-profit, include contact name and title) Name Address City Phone Email Public AccessPrivate Access 6. Name By Which Tree is Known Name Why is the tree so named? 7. Tree(s) Description – Health Excellent (no visible or known defects or health problems)Good (appears in good health with only minor defects)Fair (appears in average heath with some obvious defect)Poor (trees in noticeable decline)Bad (tree is in severe decline)Dead (Heritage Tree only). Please indicate below when tree died and how, if known If applicable, how did the tree die? – Species (Include at least the common name, and genus and species if possible, i.e. Black Walnut, Juglans nigra) Common Name Scientific Name – Measurements Provide if possible Trunk circumference at 4 1⁄2 feet above ground (inches) Total tree height (feet) Average crown spread (feet from trunk) Age (years, if known) – Land Use ResidentialCommercialWoodlandFarmlandCemetery – Photographs (A set of non-returnable color prints of the tree(s) is required with the application) Maps or diagrams of locations are also helpful. **The applicant grants TUFC all rights and privileges to the images and information attached to, or included in, this application.** 8. Applicant Information Name Title & Organization Address Phone Email Although the Tennessee Urban Forestry Council encourages the owner of each Landmark and to give it proper arboricultural care, the Tennessee Urban Forestry Council does not certify the tree as being safe or without hazard for the visiting public. All applications received on or before May 31st will be reviewed in the current year. Thank you! Your nomination has been submitted and is pending review.