(b) The application form shall require the following information:

1. (1) Identify taxpayer by name and type of ownership (individual, corporation, partnership, etc.);
2. (2) List of officers, Subchapter S shareholders with percentage of ownership, partners with percentage of ownership, etc.;
3. (3) Federal employer identification number or Social Security numbers for business or individuals to claim credit;
4. (4) Address, telephone, and facsimile numbers of all participating taxpayers;
5. (5) Contact person's name, address, telephone, and facsimile numbers;
6. (6) Record acceptable to the department that demonstrates that the interest conveyed meets the Arkansas Natural Resources Commission’s definition of qualified real property interest;
7. (7) Legal description of qualified real property interest;
8. (8) Qualified appraisal of the property interest;
9. (9) Record acceptable to the department demonstrating that interest conveyed belonged to the donor prior to conveyance;
10. (10) Name and contact information of donee that has accepted the qualified real property interest;
11. (11) A copy of the executed document illustrating that a qualified donee has accepted the property interest;
12. (12) Location of project, including maps and description of site location (e.g., county, section, township, range, latitude, longitude, watershed, etc.);
13. (13) Name of water body or bodies benefited by the donated qualified real property interest, if applicable;
14. (14) Donee’s representation that this donation would qualify as a qualified conservation contribution pursuant to 26 U.S.C. § 170(h); and
15. (15) Additional relevant information may be requested by the Private Wetland and Riparian Zone Creation, Restoration, and Conservation Committee and the department as deemed necessary for a complete review of the proposed donation.