FSA-2042 Assignment of proceeds & consent to payment

This form is available electronically.

Form Approved - OMB No. 0560-XXXX
Position 1

U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency

FSA-2042
(Proposal 7)

CONSENT TO PAYMENT OF PROCEEDS FROM SALE OF PRODUCTS

(See Page 2 for Privacy Act and Public Burden Statements).

PART A - GENERAL
1. Name and Address of Seller

2. Name and Address of Purchaser

3. Seller's Telephone Number

4. Purchaser's Telephone Number

5. Effective Date of Consent

6. Products Purchased

PART B - SELLER AGREEMENT
1. The United States, acting through the U.S. Department of Agriculture, Farm Service Agency (FSA), holds a perfected
security interest in the above named products, and in the proceeds thereof, which security interest shall remain in full force and
effect. However, until the Purchaser is otherwise notified in writing by FSA, such security interest in any such product sold to, by,
or through the Purchaser will be satisfied only upon payment, therefore, by the Purchaser to FSA:
(a)
(c) $
payable (d)

percent of the purchase price figured to the nearest dollar, payable (b)
of the purchase price or the full purchase price if less than that amount

all proceeds from sales in excess of (e) $
payable (f)
until FSA releases or suspends this assignment in writing, giving notice of that action to Purchaser.

2. This consent supersedes any previous consent from FSA or assignment to FSA by the Seller regarding such payments.
3A. Signature of Seller

3B. Date

PART C - PURCHASER ACCEPTANCE
1. The undersigned consents to the above and agrees to remit the sum of money provided above, when due and payable. If payment
is made by check, the check will be payable and delivered as provided below:
(a) To the order of the Farm Service Agency
(b) Jointly to the order of the Seller and the Farm Service Agency
(c) To the order of

2. Name of Purchaser's Duly Authorized Officer for Purchaser

3. Title

4. Signature

5. Date

Page 2 of 2

FSA-2042 (Proposal 7)
PART D - FSA USE
1. Name of Agency Official

2. Title

3. Signature

4. Date

5. Address of FSA Office

6. Telephone Number

NOTE:

The following statements are made in accordance with the Privacy Act of 1974 (5 USC 552a): the Farm Service Agency (FSA) is authorized by the Consolidated
Farm and Rural Development Act, as amended (7 USC 1921 et seq.), or other Acts, and the regulations promulgated thereunder, to solicit the information
requested on its application forms. The information requested is necessary for FSA to determine eligibility for credit or other financial assistance, service your loan,
and conduct statistical analyses. Supplied information may be furnished to other Department of Agriculture agencies, the Internal Revenue Service, the
Department of Justice or other law enforcement agencies, the Department of Defense, the Department of Housing and Urban Development, the Department of
Labor, the United States Postal Service, or other Federal, State, or local agencies as required or permitted by law. In addition, information may be referred to
interested parties under the Freedom of Information Act (FOIA), to financial consultants, advisors, lending institutions, packagers, agents, and private or
commercial credit sources, to collection or servicing contractors, to credit reporting agencies, to private attorneys under contract with FSA or the Department of
Justice, to business firms in the trade area that buy chattel or crops or sell them for commission, to Members of Congress or Congressional staff members, or to
courts or adjudicative bodies. Disclosure of the information requested is voluntary. However, failure to disclose certain items of information requested, including
your Social Security Number or Federal Tax Identification Number, may result in a delay in the processing of an application or its rejection.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information
unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0560-XXXX. The time required to complete this
information collection is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the collection of information. RETURN THIS COMPLETED FORM TO:

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where
applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual's
income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for
communication of program information (Braille, large print, audiotape, etc.) should contact USDA's TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of
discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202)
720-6382 (TDD). USDA is an equal opportunity provider and employer.