ASSIGNMENT OF PROCEEDS FROM THE SALE OF DAIRY PRODUCTS AND RELEASE OF SECURITY INTEREST.
Customers who have established electronic access credentials with USDA may electronically transmit this form to the USDA servicing office, provided that the customer submitting the form is the only person required to sign the transaction.
Features for transmitting the form electronically are available to those customers with access credentials only. If you would like to establish online access credentials with USDA, follow the instructions provided at the USDA eForms web site.
Items 1A and 1B completed by FSA.
Field Name/
|
Instruction |
2A Seller/ Borrower's Name and Address |
Enter the name and address of seller/borrower including Zip Code. |
2B Seller/ Borrower’s Telephone Number |
Enter the seller/borrower's telephone number including Area Code. |
3A Purchaser's Name and Address |
Enter the name and address of purchaser including Zip Code.
|
3B Patron Account Number |
Enter the seller/borrower's Patron Account Number as assigned by the purchaser. |
3C Purchaser's Telephone Number |
Enter the telephone number of purchaser including Area Code. |
4 County of Residence of Seller/ Borrower |
Enter the seller/borrower's county of residence. |
5 Effective Date of Assignment |
Enter the effective date of this assignment (MM-DD-YYYY). This is the date that the assignment will begin. |
6(a)(1) Percent of Purchase Price |
Enter a checkmark in the checkbox and the percent of the purchase price payable, if known, otherwise leave blank |
6(a)(2) Payment Schedule |
Enter the payment schedule, monthly, bi-monthly or other. |
6(b)(1) Purchase Price |
Enter a checkmark in the checkbox and the portion of the purchase price payable, if known, otherwise leave blank. |
6(b)(2) Payment Schedule |
Enter the payment schedule, monthly, bi-monthly or other. |
6(c)(1) Amount of Purchase Price |
Enter a checkmark in the checkbox and the dollar amount of proceeds from sale in excess payable, if known, otherwise leave blank. |
6(c)(2) Payment Schedule |
Enter the payment schedule, monthly, bi-monthly or other. |
6(d) Special Instructions |
Enter special instructions or explanations, if applicable.
|
7A Seller/ Borrower's Signature |
Enter the seller/borrower's signature. |
7B Date |
Enter the date (MM-DD-YYYY) the seller/borrower signed this form. |
Field Name/
|
Instruction |
8(a) To FSA |
Enter a checkmark in the checkbox if the payment is payable to the order of FSA. |
8(b) Jointly to Seller, Buyer, and FSA |
Enter a checkmark in the checkbox if the payment is payable jointly or the check will be sent to FSA and the borrower/seller. |
8(c) To Bank |
Enter a checkmark in the checkbox if the check is made payable to a bank and enter the bank's name and address including Zip code. |
9A Signature of Duly Authorized Officer |
Enter the signature of the Duly Authorized Officer for the purchaser. |
9B Title |
Enter the title of Duly Authorized Officer for the purchaser. |
9C Date |
Enter the date (MM-DD-YYYY) the purchaser signed this form. |
Items 10(a) through 10(c) completed by FSA.
Items 11A through 11F completed by Purchaser.
|
|
11A Read the information in Item 11A |
Read the information in Item 11A in order to complete codes 1 through 4 in Item 11F. |
11B Purchaser's Name |
Enter the name of the purchaser. |
11C Purchaser's Address |
Enter the address of the purchaser. |
11D Amount of Deduction |
Enter the dollar amount of the deduction. |
11E Effective date |
Enter the effective date (MM-DD-YYYY) when the purchaser accepted the prior assignment or claim. |
11F Deduction Priority Codes |
Enter the deduction priority code in Item 11F. To determine which code to enter in Item11F, use one of the codes from Item 11A.
|
File Type | application/msword |
File Title | Instructions for FSA-441-25 |
Author | gg330 |
Last Modified By | USDA-MDIOL00000DG8C |
File Modified | 2004-04-12 |
File Created | 2004-04-12 |