TREE REMOVAL REQUEST FORM

Hickory Hills Landowners, Inc.
P.O. Box 298
Lunenburg, MA 01462
Telephone 978-582-6365

TREE REMOVAL REQUEST FORM

Board decisions are made during regular Board meetings held the 2nd Thursday of each month.

Hickory Hills property owner deed provision:

#8 "No trees now located upon said property and having trunks measuring four (4) inches or more in diameter at a point one (1) foot above the surface of the ground shall be cut down or removed from said property without prior written approval of the Hickory Hills Lake Corporation, its successors and assigns."

Name:
	(Please Print)
Name:
	(Signature)
Address:
Telephone:

REASONS FOR TREE REMOVAL REQUEST

Please mark trees for inspection by Board members, attach any diagrams or supporting information.

Do not write below this line. FOR OFFICE USE ONLY.

Trees inspected by:			Approved	Not Approved

Name: _____________________________	  _____	        _____

Name: _____________________________	  _____	        _____

Reasons:  _______________________________________________________________

          _______________________________________________________________

Board of Directors vote on request:	Approved	Not Approved

    Date:  _______________________	  _____	        _____

Reply sent to property owner:

    Date:  _______________________

Revised as of 11/14/2002

11/14/2002