Tuesday, August 15, 2017
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Tree Commission

Requestor Form for the Modification of Trees on Public Property

 The form below should be printed, filled out and mailed to;

Middletown Tree Commission

Middletown Town Hall 

350 East Main Road

Middletown, RI 02842 

 

 

Tree Removal or Tree Pruning Request Form

 

 

Please Check One:   ______  Tree Removal             ______  Tree Pruning

 

Name of property owner requesting removal/pruning.__________________________________

Address of property owner:

 

Street:__________________________

 

City/Town:_________________________ State__________   Zip Code______________

 

Phone Number: Home/Business:_____________________ Mobile:______________________

 

Location of tree to be considered (if different than above):

 

Street:___________________________________________________________________

 

Reason for the request: (Check all that apply.)

 

____  Tree is damaged or diseased.              ____  Tree is a hindrance to vehicles/pedestrians

 

____Tree is in an authorized right-of-way      ____ Other (Please describe below.)

 

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

Name and address of licensed and insured arborist completing the work if not the Town:

 

____________________________________________________________________________

____________________________________________________________________________

 

 

__________________________________                ______________________

Signature of property owner                                       Date

——————————————————————————————————————————

For Office Use Only

Person (Persons) at site visit:____________________________________________________

________________________________________________________________________________________________________________________________________________________

Date of visit:_______________________________________________

 

____ Tree removal accepted.                                    ____  Tree pruning accepted

 

____  Tree removal not accepted.                 ____ Tree pruning not accepted

 

(Continued on the back.)

 

Reason: _____________________________________________________________________

________________________________________________________________________________________________________________________________________________________

 

_____________________________________                      _________________________

Authorized signature                                                               Date