Form 7-21XS Designation of Excess Land

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OMB CONTROL NO.: 1006-0005

FORM 7-21XS
2008

DESIGNATION OF EXCESS LAND
For Certification and Reporting Requirements of the
Reclamation Reform Act of 1982

(7-07)

Districts must complete the “District Name” and “Date Received” boxes.
District Name:
DATE RECEIVED:

Help - Date Received Block
Do not use this form after December 31, 2008. It is important that you read the separate instructions that accompany this form before completing it. If you did not receive these
instructions, please contact your district office. Type or print in ink. Date and initial crossouts and corrections. Visit www.usbr.gov/rra for more information.

BUREAU OF RECLAMATION

1.

Landholder name:

2.
Spouse name, if married:
3(a). Landholder’s, trustee’s, executor’s, or administrator’s street address or rural route number,
city, state, and ZIP code:

4(a). Telephone number where questions can be directed: (
5.
160 Acres
Landholder’s ownership entitlement:

□

)

□ 320 Acres

3(b). Mailing address if different from street address:

4(b). Contact person:

□ 640 Acres

□ 960 Acres

□ Other: ____________Acres

□Trust or estate

6(a). Entities only: If the reason for completing this form is due solely to a part owner’s need to designate land as excess, identify the part owner(s):

6(b). Trusts/Estates only: Identify the attributed direct/indirect landowner(s) who exceeds their ownership entitlement, causing the trust/estate to complete this form:

7.

List all directly owned land to be designated nonexcess. Refer to the separate instructions for further guidance regarding the use of columns (d) and (e). For additional space, use attachments.
(a)
District Name

8.

(c)
Actual Acres

(d) Class 1
Equivalency Factor

(e) Class 1
Equivalent Acres

List all indirectly owned land to be designated nonexcess. This information must be obtained from the direct landowner’s “Designation of Excess Land” (Form 7-21XS) if such a form has been
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completed by the direct landowner. Refer to the separate instructions for further guidance regarding column (c). For additional space, use attachments.

(a)
District Name

9.

(b)
Legal Description of Land Parcel(s) or Assessor’s Parcel Number (s)

(c)
Acres Designated
as Nonexcess
by the Direct
Landowner

(b)
Direct Landowner
(Entity, Trust, or Estate Name)

(d)
Type of Acres
Included in Item 8(c):
(check one)
Actual

Class 1
Equivalent

(e)
Percentage
Attributed
to This
Landholder

(f)
Number of
Nonexcess Acres
Attributed to This
Landholder
(c X e)

TOTAL NONEXCESS ACREAGE (use the workspace provided in the instructions for item 9 to calculate this total):
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FORM 7-21XS (2008)
10. LANDHOLDER NAME:

If using attachments, READ

11. List excess land this landholder directly owns westwide. Refer to the separate instructions that accompany this form for special direction regarding item 11(d). For additional space, use attachments.

(a)
District Name

(c)
Type of Irrigation
Water Received

(b)
Legal Description of Land Parcel(s) or Assessor’s Parcel Number(s)

Project

Nonproject

None

(d)
If “Project” is checked in item (c), explain why
land is eligible (e.g., involuntary acquisition,
recordable contract, etc.)
NOTE: If land is receiving water under the involuntary
acquisition provisions, see the separate instructions on
this form.

(e)
Number of
Actual
Excess Acres

TOTAL NUMBER OF ACTUAL EXCESS ACRES THIS LANDHOLDER DIRECTLY OWNS WESTWIDE
12.
13. List excess land indirectly owned westwide that is attributed to this landholder by this landholder’s interest in an entity, trust, or estate. This information must be obtained from the direct landowner’s
“Designation of Excess Land” (Form 7-21XS). Refer to the separate instructions for further guidance regarding column (c). For additional space, use attachments.
(c)
Actual Acres
Designated as
Excess by the
Direct Landowner

(b)
Direct Landowner
Enity, Trust or Estate Name)

(a)
District Name

(d)
Percentage
Attributed to
This
Landowner

14.

TOTAL NUMBER EXCESS ACRES THIS LANDHOLDER INDIRECTLY OWNS WESTWIDE

15.

TOTAL EXCESS ACREAGE (this is the sum of item 12 and item 14)
SIGNATURE(S)

16.

(e)
Number of
Excess Acres Attributed to
This Landowner
(c X d)
?

This form must be signed and dated as well as the standard form it accompanies. The spouse of a married, individual landholder must sign this form. This requirement applies even if the land is not jointly held.
You may use a written spousal signature authorization to permit one spouse to sign for the couple. All partners, joint tenants, or co-tenants must sign this form. However, a written signature authorization may
be used to permit one natural person to sign for the entity. All trustees, executors, or administrators must sign this form unless the trust or a power of attorney authorizes one individual to sign for the trust or
estate.

Signature of Landholder, Authorized Agent,
Trustee, Executor, or Administrator

Date

Agent’s Title (if applicable) or Other Required Signature and Date

Spouse’s Signature or Other Required Signature

Date

Other Required Signature

Date

Other Required Signature

Date

Other Required Signature

Date

PLEASE RETURN THIS FORM TO THE APPROPRIATE DISTRICT OFFICE(S).

Please read

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OMB CONTROL NO.: 1006-0005

ATTACHMENT SHEET FOR FORM 7-21XS
(IDENTIFICATION OF INVOLUNTARILY ACQUIRED LAND)
[Required Information for Item 11(d) of Form 7-21XS]

FORM 7-21XSINAQ
2008

For Certification and Reporting Requirements of the Reclamation
Reform Act of 1982

(7-07)
BUREAU OF RECLAMATION

Do not use this form after December 31, 2008. Separate instructions for the completion of this form are on the reverse side of this page. You may use this attachment sheet to provide required information if
you involuntarily acquired eligible land and designated that land as excess, or you may use your own similar attachment sheet. Type or print in ink. Date and initial crossouts and corrections. Use as many
of these attachment sheets as necessary. Visit www.usbr.gov/rra for more information.

LANDHOLDER NAME:
INVOLUNTARILY ACQUIRED ELIGIBLE LAND DESIGNATED AS EXCESS

(1)
Legal Description of Land Parcel or
Assessor’s Parcel Number

(2)
Name of the Landholder
From Whom Each Parcel Was
Involuntarily Acquired

Please read

(3)
Date Each Parcel
Was Involuntarily
Acquired
(m/d/yr)

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(5)
(6)
If the Land Was
Acreage Limitation
Excess When It Was
(4)
Status of the
Involuntarily Acquired,
Status of the Parcel
Landholder From
Why Is the
When It Was
Whom the
Involuntarily Acquired Land Eligible to Receive
Land Was
Reclamation Irrigation
Involuntarily Acquired
Water?

(7)
Water Rate
Applicable for
Reclamation
Irrigation Water
Delivered To the
Previous Landholder

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