County of Kaua‘i

This is the recommended form for the nomination of “Exceptional Trees”. While this form is suggested, nominations may also be made in other formats such as letters or petitions. Applicants should fill in all known information.

The “Exceptional Tree” designation is per Article 22-5, Revised Code of Ordinances (RCO), and reference #240, as amended.

Overall Criteria: Trees should be considered based on their “...historical, or cultural value, aesthetic quality, endemic status, age, rarity, location, or size...”

Date: ________________

Nominator

Name: __________________________________________ Phone Number: ________________

Address: ______________________________________________________________________

Name of Tree

Local/Common: ________________________________________________________________

Botanical: _____________________________________________________________________

Location

Place Name: ___________________________________________________________________

TMK: ________________________________________________________________________

Owner

Name: __________________________________________ Phone Number: ________________

Address: ______________________________________________________________________

Attributes

Age: ___________________ Diameter: _______________ Height: ___________

Vigor/Health: __________________________________________________________________

______________________________________________________________________________

Qualifying Criteria (Attach additional sheets as needed): _______________________________

______________________________________________________________________________

Other Comments (Attach additional sheets as needed): ________________________________

______________________________________________________________________________

Attachments

Maps: _________________ Photos: _________________ Other: ____________

Forms available at:

Office of Boards and Commissions

4444 Rice Street, Suite 150

Līhu‘e, HI 96766