APPENDIX –III
FORM A
(See rule 3)
The Tree Officer,
……………………..
Sir,
I have to report that I have felled on ……(date) at ………(time). ……(number)/tree from the property owned by me/under my occupation in the village ……Taluka………and District… I declare that if the said tree/s had not been immediately felled, it/they would have posed grave danger to life/property/ traffic (delete inapplicable words).
2. The following details are furnished: -
i) Name and full address of the signatory (In Block letters).
ii) Title in respect of land in which tree(s) was/were situated.
iii) Location of the site form which tree/s felled (give name and survey number of plot and indicate as clearly as possible the actual situation of the tree)
iv) a) Species of the tree felled
b) Its approximate age
c) Its girth measured at a height of 1.35 meters from ground level.
v) Justification for felling the tree/trees (Here describe the way in which the tree posed danger and the reasons why you could not wait to seek permission for cutting it).
Place: -
Date:
SIGNATURE