Form 7-21SUMM-C District Summary of Certification and Declaration Forms

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1. District Name:
DISTRICT SUMMARY OF CERTIFICATION
AND DECLARATION FORMS

FORM 7-21SUMM-C
2008

OMB CONTROL NO.: 1006-0006

2.

3. Project, unit, and/or division name:

IDCON Number:

4. Region:

(7-07)
BUREAU OF RECLAMATION

Do not use this form after December 31, 2008. Type or print in ink. Date and initial crossouts and corrections. Visit www.usbr.gov/rra for more information.
5(a).

District’s forms submittal category for the 2008 water year (check one):

5(b).

Will the District deliver Reclamation irrigation water this year (check one):

Help Item 6

(a)
Number of
Landholders

(b)
Number of
Multidistrict
Landholders

□1
□ YES

Acreage Directly
Owned
(c) Number

(d) Acres

□
□

2
NO

Acreage Leased
FROM Other Parties
(e) Number

(f) Acres

Excess Acreage
(g) Number

(h) Acres

Full-Cost
Acreage
(i) Number

(j) Acres

Acreage Leased
TO Other Parties
(k) Number

(l) Acres

6. Individuals and entities
Qualified Recipients 80 through 960
(For districts with forms submittal category 2 only)

Qualified recipients 240 through 960
(For districts with forms submittal category 1 only)

Qualified recipients over 960
Limited recipients 40 through 320
Limited recipients over 320 through 640
Limited recipients over 640
Subtotal for individuals and entities
7. Trusts and estates
40 through 960
Over 960
Subtotal for trusts and estates

Note

8.

Public entities

9.

Religious and charitable organizations

10. Landholdings below
certification threshold
11. Noncertifying landholdings
above certification threshold
12.
13.

TOTAL
I ATTEST THAT THIS INFORMATION IS BASED ON LANDHOLDERS’ CERTIFICATION FORMS AND ACCURATELY REPRESENTS THE INFORMATION SUBMITTED BY THE LANDHOLDERS. I
FURTHER ATTEST THAT ALL KNOWN ERRORS, OMISSIONS, AND DISCREPANCIES IN THE LANDHOLDERS’ FORMS ARE LISTED ON FORM 7-21SUMM-C, TABULATION E. THIS FORM MUST BE
SIGNED AND DATED BY AN AUTHORIZED DISTRICT OFFICIAL.

Signature

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Title

Date

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FORM 7-21SUMM-C
Tabulation A
2008

OMB CONTROL NO.: 1006-0006
BUREAU OF RECLAMATION

Instructions Link

DISTRICT SUMMARY OF CERTIFICATION AND
DECLARATION FORMS
TABULATION A of Individual and Entity Certification Forms
(Forms 7-2180, 7-2180EZ, and 7-2181)

1. District Name:

Help (3)

2. Region:

(7-07)

3. Page ____ of _____

Do not use this form after December 31, 2008. Type or print in ink. Date and initial crossouts and corrections. Visit www.usbr.gov/rra for more information.
4. LANDHOLDINGS OF (choose only one):
□Qualified Recipients
□Qualified Recipients
□Qualified Recipients
□Limited Recipients
□Limited Recipients
80 through 960
(District Category 2)

Over 960

(b)

(a)
Landholder Name

Multidistrict

5.

240 through 960
(District Category 1)

(c)
Acreage* Directly
Owned in
This District

40 through 320

(d)
Acreage* Directly
Leased FROM Other
Parties
in This District

Over 320 through 640

□Limited Recipients
Over 640

(e)
Directly Owned Excess
Acreage*
in this District

(f)
Directly Held
Full-Cost Acreage*
In This District

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
(16)
(17)
(18)
(19)
(20)

6.
7.

TOTAL NUMBER OF ACRES

Calculate Landholders
TOTAL NUMBER OF LANDHOLDERS

(a)

(b)

(a)

(b)

(c)

(d)

(c)

(d)

(e)

(f)

[on this page]

*Irrigable and/or irrigation acres.

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FORM 7-21SUMM-C
Tabulation B
2008

Required Information

OMB CONTROL NO.: 1006-0006
BUREAU OF RECLAMATION

Instructions Link

DISTRICT SUMMARY OF CERTIFICATION AND
DECLARATION FORMS
TABULATION B of “Declaration of Trust's or Estate's
Landholdings” Forms
(Forms 7-21TRUST)

1. District Name:

2. Region:

Help (3)

(7-07)

3. Page ____ of _____
Do not use this form after December 31, 2008. Type or print in ink. Date and initial crossouts and corrections. Visit www.usbr.gov/rra for more information.

4.

LANDHOLDINGS OF (choose only one):

□ 40 through 960

□ Over 960

5.

Multidistrict

(b)
(a)
Landholder Name

(d)
Acreage* Directly
Leased FROM
Other Parties
in This District

(c)
Acreage* Directly
Owned in
This District

(f)
Directly Held
Full-Cost Acreage*
In This District

(e)
Directly Owned Excess
Acreage*
in this District

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
(16)
(17)
(18)
(19)
(20)

6.
7.

Calculate Landholders

TOTAL NUMBER OF ACRES

TOTAL NUMBER OF LANDHOLDERS

(a)
[on this page]

(b)

(a)

(b)

(c)

(d)

(c)

(d)

(e)

(f)

*Irrigable and/or irrigation acres.

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DISTRICT SUMMARY OF CERTIFICATION AND
DECLARATION FORMS

FORM 7-21SUMM-C
Tabulation C
2008

TABULATION C of “Declaration of Public Entity’s
Landholdings” Forms
(Form 7-21PE)

OMB CONTROL NO.: 1006-0006
BUREAU OF RECLAMATION

1. District Name:

2. Region:

Help

(7-07)

3. Page _____ of ______

Do not use this form after December 31, 2008. Type or print in ink. Date and initial crossouts and corrections. Visit www.usbr.gov/rra for more information.
(b)

4.

Multidistrict

(a)
Public Entity Name

(c)
Acreage* Owned
and NOT Leased to
or NOT Operated by
Other Parties in This
District

(d)
Acreage* Owned
and
Leased to or
Operated by Other
Parties
in This District

(e)
Acreage* Directly
Owned and
Subject to
Acreage Limitation
Application in This
District

(g)
(f)
Directly Owned
Acreage* Directly
Leased and Subject Excess Acreage*
in This District
to Acreage
Limitation
Application in This
District

(h)
Directly Held
Full-Cost Acreage*
in This District

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
(16)
(17)
(18)
(19)
(20)

5.
6.

Calculate Landholders

TOTAL NUMBER OF ACRES

TOTAL NUMBER OF LANDHOLDERS

(a)

(b)

(a)

(b)

(c)

(d)

(e)

(f)

(c)

(d)

(e)

(f)

(g)

(h)

[on this page]

Please read

*Irrigable and/or irrigation acres.

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OMB CONTROL NO.: 1006-0006
BUREAU OF RECLAMATION

1. District Name:
DISTRICT SUMMARY OF CERTIFICATION AND
DECLARATION FORMS
TABULATION D of “Certification of Religious or Charitable
2. Region:
Organization’s Landholdings” Forms
(Form 7-2184)

FORM 7-21SUMM-C
Tabulation D
2008

Help (3)

3. Page ____ of _____
Do not use this form after December 31, 2008. Type or print in ink. Date and initial crossouts and corrections. Visit www.usbr.gov/rra for more information.

(7-07)

(c)
Acreage* Directly
Owned in
This District

(b)

4.

Multidistrict

(a)
Landholder Name

(d)
Acreage* Directly
Leased FROM
Other Parties
in This District

(f)
Directly Held
Full-Cost
Acreage in
This District

(e)
Directly Owned Excess
Acreage*
in This District

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
(16)
(17)
(18)
(19)
(20)

TOTAL NUMBER OF ACRES

5.

Calculate Landholders
6.

(a)

TOTAL NUMBER OF LANDHOLDERS

(b)

(a)

(b)

(c)

(d)

(c)

(d)

(e)

(f)

[on this page]

Please read

*Irrigable and/or irrigation acres.

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Required Information

OMB CONTROL NO.: 1006-0006
BUREAU OF RECLAMATION

Instructions Link

FORM 7-21SUMM-C

DISTRICT SUMMARY OF CERTIFICATION AND
DECLARATION FORMS

Tabulation E
2008

TABULATION E of Certification Form Errors,
Omissions, and Discrepancies

1. District Name:

2. Region:

Help (3)
3. Page ____ of _____

(7-07)

Do not use this form after December 31, 2008. Type or print in ink. Date and initial crossouts and corrections.
For additional space, use as many copies of this sheet as necessary. Visit www.usbr.gov/rra for more information.
4.
Landholders that hold land over the threshold requiring certification, that did not receive Reclamation irrigation water, and that did not submit a form:
Landholder Name
Landholder Name
Number of Acres
in This District
(1)

(8)

(2)

(9)

(3)

(10)

(4)

(11)

(5)

(12)

(6)

(13)

(7)
5.

Number of Acres
in This District

(14)
Landholders that hold land over the forms submittal threshold that received Reclamation irrigation water, and that did not submit a form:
(a) Landholder Name
(b) Reason or Explanation for Water Delivery

(1)
(2)
(3)
(4)
(5)
Landholders that hold land over the threshold requiring certification, that submitted a form, but had an error, omission, or discrepancy on the form:
(b) Received Water?
(a) Landholder Name
(c) Explanation of the Error, Omission, or Discrepancy
YES
NO

6.

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)

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FORM 7-21SUMM-C

DISTRICT SUMMARY OF CERTIFICATION AND
DECLARATION FORMS

Tabulation F
2008

TABULATION F of Part Owners Subject to
Discretionary Provisions

OMB CONTROL NO.: 1006-0006
BUREAU OF RECLAMATION

1. District Name:

2. Region:

Help (3)
3. Page ____ of_____

(7-07)

Do not use this form after December 31, 2008. Type or print in ink. Date and initial crossouts and corrections. List only indirectly held lands. DO NOT transfer information from this sheet to Form 7-21SUMM-C,
“District Summary of Certification and Declaration Forms.” This tabulation sheet is provided for district convenience only and is not required pursuant to the Reclamation Reform Act of 1982 forms requirements.
Visit www.usbr.gov/rra for more information.

(a)
Part Owner Name

(b)
Name of Entity

Multidistrict

(c)

4.

(d)
Does This Part
Owner Have
Owned or
Leased Lands in
Their Name in
This District?
YES

(e)
Acreage*
Indirectly
Owned
Through
Entities in
This District

(f)
Acreage*
Indirectly
Leased
Through
Entities in
This District

(g)
Indirect
Excess
Acreage* in
This District

(h)
Indirect
Full-Cost
Acreage* in
This District

NO

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
(16)
(17)
(18)
(19)
(20)

5.
6.

Calculate Landholders

(a)
TOTAL NUMBER OF LANDHOLDERS [on this page]

TOTAL NUMBER OF ACRES

Please read

(b)

(a)

(b)

(c)

(d)

(c)

(d)

(e)

(f)

*Irrigable and/or irrigation acres.

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FORM 7-21SUMM-C

DISTRICT SUMMARY OF CERTIFICATION AND
DECLARATION FORMS

Tabulation G
2008

OMB CONTROL NO.: 1006-0006
BUREAU OF RECLAMATION

Instructions Link

TABULATION G of “Declaration of Farm Operator Information” Forms
(Form 7-21FARMOP)

1. District Name:

2. Region:

Help
3. Page _____ of ______

(7-07)

Do not use this form after December 31, 2008. Type or print in ink. Date and initial crossouts and corrections. Visit www.usbr.gov/rra for more information.
4.

(b)
Part Owner Names

(a)
Farm Operator Name

(c)
Number of
Acres* in
This District

(d)
How did the
farm
operator
Respond to
item 18?
Yes

TOTAL NUMBER OF ACRES

5.
6.

Calculate Landholders

TOTAL NUMBER OF FARM OPERATORS

Please read

No

(e)
How did the farm
operator respond to
item 19?
Yes

No

[on this page]

[on this page]

*Irrigable and/or irrigation acres.

Print Form

N/A