CPC Short Form

Town of Wellesley Conservation Preservation Committee
SHORT FORM PRELIMINARY APPLICATION

Community Preservation Act (CPA) funds may be used for projects in the areas of open space, housing, historical preservation and recreation. CPA funds are generated from a 1% surcharge on our local property tax bills and are matched by the State through increased filing fees at the registries of deeds.
Date

MonthDayYear
Name

First NameLast Name
E-mail
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Sponsoring Organization(s)
CPA Category(ies)

Open SpaceHistoric PreservationRecreationHousing
Brief Description of Project
Goals
Community Need
Time Line
Maintenance/ongoing costs
Other pertinent information (zoning changes, etc.)
Amount of CPA Request *
Other funding source(s) and amount(s) of funding
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Should be Empty:

Town of Wellesley Conservation Preservation Committee