EVIDENCE QUESTIONNAIRE IN SUPPORT OF REGISTRATION AS A TOWN OR VILLAGE GREEN

Evidence Form based on that produced by the Open Spaces Society

The purpose of this form is to obtain more information to help establish whether or not there is a village green on the land
claimed. You are asked to complete the questions as fully and accurately as possible in order to allow the County Council
to make a more accurate decision with more information available.

Note to witness filling in the form:1) You should fill in this form personally and sign it yourself at the end.
2) A map is enclosed of Long Lawford. Please mark on the map the address(es) where you live/have lived whilst using the
land marked with an X.
3) In addition to signing the form you must ALSO sign the map attached, confirming it relates to the evidence provided by
you. ( Map A is the map showing the claimed land , and the claimed locality which use the land , which should accompany
the this form and which will subsequently accompany the application.
4) The information provided in this form will be provided to the Land Owner and to any other person having a right to
request details of documentary evidence taken into account when considering this claim. The data is collected by
Warwickshire Council in accordance with the data protection principles in the Data Protection Act 1998. The purpose for
collecting the data is to enable the Council to investigate the claim for a Town or Village Green in accordance with the
Commons Act 2006.
NAME:

ADDRESS:

POSTCODE:

TELEPHONE NO:

1. Please fill in the following table:Address(es) where you live(d) Date(s) of Residence including postcode(s) when you used the Land
Distance From To

from the Land (1)

(2)
(3)
Please continue on separate sheet if necessary so that all addresses for your period of use are accounted for.

2A. By what name is the land on Map A known?

...................................................................... ...........................................................................................................................
2B. Did you sign the reverse of the Map? YES /NO
2B. Please mark on the map the location of your house with an X.
2C. Please confirm that you agree with the boundaries of the locality (or Neighbourhood within a locality) on Map
A edged in RED.

3. Has it ever to your knowledge been known by any other name: If so, what name?

4. How many years have you known the Land?

From . To.
No of YEARS .

5. Between which years did you use it:

From . To.

6. Do you consider yourself to be a local inhabitant in respect of the Land?

...
7. Are you able to give a name to the locality to which the Land belongs?
8. During the time you have used the Land, has the general pattern of use remained basically the same?

9. What recognisable facilities are available to the local inhabitants of your locality?
Please tick all boxes and add any OTHER additional matters not covered.
School Catchment Area

Local School Area Policeman

Residents Association

Doctors Surgery

Community Centre Community Activities

Local Church or Place of Worship

Neighbourhood Watch

Sports Facility A Central Feature

Local Shops

Scout Hut

Working Mens Club

Public House

Other (please state) ................

10. To your knowledge are there any public paths (e.g. public footpaths or bridleways) crossing the Land?

11. How do/did you gain access to the Land? ...............................

12. Why did you go on to this piece of Land? ...............................
13. How often have you used the Land (apart from the public paths)?If different frequency for different periods of time
please specify.
..................................................
14. What activities have you taken part in during the years you have used the land?

15. Does your immediate family use the Land? ................................................................................

16. If so, what for? ................................................................................................................................

17. Do you know of any community activities that take place or have taken place on the Land?
.....................................................
18. Please list them and state when and for how long they have taken place.
.....................................................
19. Do you participate in any of them? ................
20. Do any organisations use the Land for sports or pastimes? If so please specify.
.....................................................
21. Do any seasonal activities take place on the Land? ...............................
22. Please tick all the activities that you have seen taking place on the Land.
Playing Football

Rounders Cricket

Fishing Bird Watching

Drawing and Painting

Picnicking

Dog Walking

Kite Flying

Bird Watching

Team Games

People Walking

Picking Blackberries

Bonfire Parties

Community Celebrations

Bicycle Riding

Fetes

Bonfire parties

Horse Riding

Other (please state) .............................................

23. Who is the current owner(s) / occupiers(s) of the Land and how did you discover this information?

24. Are you aware of any other owner(s) / occupier(s) of the Land, past or present? Please give details including
dates.
................................................................
24B. Are you his/her employee? ................
24C Are you his/her tenant? ................
25. Have any of the owner(s) / occupier(s) seen you on the Land? ...............................
26. How exactly were you able to identify this person or these persons as the
owner(s) / occupier(s) of the Land? ................................................
27. What did the owner(s) / occupier(s) say? Was your alleged right to be on thevLand challenged?
....................................................................
28. Was permission ever sought by you for activities on the Land? ..............
29. If so, from whom, why and when? ....................................................
30. Did anyone ever give you permission to go onto the Land? ..................................
31. If yes, when and the reason? ............................................................
32. Have you ever been prevented from using the Land? .............................................

33. If yes, when and the reason? ................................................

34. Has any attempt ever been made by notice or fencing or by any other means to prevent or discourage the use
being made of the Land by the local inhabitants?
....................................................................
35. If yes, give examples.
................................................................

Declaration of Truth

I hereby certify that to the best of my knowledge and belief the facts that I have stated are true.

Signature: ................................................
Date: ................

MAP A
New Housing Estates

Claimed Land Proposed

Village Green Area

Claimed Locality which use

the land

Signature

** Please sign this map to confirm that it relates to the evidence provided by you on the questionnaire
*** Please mark on the map your current residence and any previous residences when you used the land