Commission Information

NAME:______________________________________________________________

ADDRESS:___________________________________________________________

CITY and STATE:_____________________________________________________

ZIP:_________________________________________________________________

PHONE #:____________________________________________________________

E-MAIL:_____________________________________________________________

Brief history of your tree. If it was on family property, please give the family name. Indicate what brought the tree down. (storm, old age, needed to be cut, etc.) _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________

Robert Lentz 13477 Evans Farm Ln. Pungoteague, VA 23422-0387 Phone (757)442-4295 E-Mail rlentz@intercom.net