FSA-441-8 Assignment of Proceeds from the Sale of Products

FORMS MANUAL INSERT

FORM FSA-441-8

Used to obtain assignment of
agriculture income from sellers
as repayment on FSA loans.

(SEE REVERSE)

PROCEDURE FOR PREPARATION

:

FSA Transferred Instruction 1941-A, FSA Handbook 3-FLP.

PREPARED BY

:

Agency Official.

NUMBER OF COPIES

:

Original and two copies.

SIGNATURE REQUIRED

:

Purchaser and the Seller.

DISTRIBUTION OF COPIES

:

Original in the County Office; copy to the Purchaser and Seller.

(12-08-04) FSA PN Issue No. 215

FMI Page 1

FORMS MANUAL INSERT

FORM FSA-441-8

INSTRUCTIONS FOR PREPARATION
Items 1A and 1B are for FSA use only.
Fld Name /
Instruction
Item No.
1A
Enter County FSA Office name and address (Including Zip Code).
County FSA
Office
Name and
Address
1B
Enter County FSA telephone number (Including Area Code).
County FSA
Telephone
Number
Items 2A through 6B are completed by the Seller.
Fld Name /
Item No.

Instruction

2A
Seller's
Name and
Address
2B
Seller's
Telephone
Number
2C
Seller's
County of
Residence
3A
Purchaser's
Name and
Address
3B
Purchaser's
Telephone
Number

Enter seller's name and address (Including Zip Code).

3C
Kind of
Product
Purchased

Enter the kind of product purchased.

Enter seller's telephone number (Including Area Code).

Enter the seller's county of residence.

Enter purchaser's name and address (Including Zip Code).

Enter the purchaser's telephone number (Including Area Code).

(12-08-04) FSA PN Issue No. 215

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FORMS MANUAL INSERT
Fld Name /
Item No.
4
Effective
Date of
Assignment

FORM FSA-441-8
Instruction

Enter the effective date of assignment (MM-DD-YYYY).

5(a)(1)
Percent of
Purchase
Price
5(a)(2)
Payment
Schedule
5(b)(1)
Purchase
Price
5(b)(2)
Payment
Schedule
5(c)(1)
Amount of
Purchase
Price in
Excess
Payable
5(c)(2)
Payment
Schedule
6
Seller
Authorizing
Statement

If the assignment will be a percent of the purchase price enter a
checkmark in the box and the percentage of the purchase price to be
paid to FSA.

6A
Signature of
Seller

Enter the signature of the seller.

6B
Date

Enter the date the seller signs this form (MM-DD-YYYY).

If Item 5(a)(1) was completed, enter the payme nt schedule such as
monthly, bimonthly, or other.
If the assignment will be a specific amount of the purchase price enter
checkmark in box and the specified amount to be paid to FSA.
If Item 5(b)(1) was completed, enter the payme nt schedule such as
monthly, bimonthly, or other.
If the assignment will be any proceeds in excess of a specified amount
to be retained by the seller, enter a checkmark in the box and the dollar
amount of sales proceeds to be retained by the seller.

If Item 5(c)(1) was completed, enter the payme nt schedule such as
monthly, bimonthly, or other.
The seller must read the authorizing statement.

Items 7 through 8C are completed by the Purchaser.

(12-08-04) FSA PN Issue No. 215

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FORMS MANUAL INSERT
Fld Name /
Item No.
7
Purchaser
Statement of
Acceptance
7(a)
To FSA

FORM FSA-441-8
Instruction

The purchaser must read the statement of acceptance.

Enter a checkmark in the box if the payment is made to the order of the
Farm Service Agency.

7(b)
Jointly To
Seller and
FSA

Enter a checkmark in the box if the payment is made jointly to the order
of the seller and the Farm Service Agency.

7(c)
To The
Order of
The Bank
8A
Signature of
Duly
Authorized
Officer
8B
Title of
Purchaser

Enter a checkmark in the box if the payment is made to the order of a
bank. Enter the name and address of the bank (Including Zip Code).

8C
Date

Enter the date the purchaser signs this form (MM-DD-YYYY).

Enter the signature of the duly authorized officer for the purchaser.

Enter the title of the purchaser.

(12-08-04) FSA PN Issue No. 215

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FORMS MANUAL INSERT

(12-08-04) FSA PN Issue No. 215

FORM FSA-441-8

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