AD-1157A Option Agreement To Purchase

U.S. DEPARTMENT OF AGRICULTURE

OMB No. 0578-0013

1. To be completed by NRCS; check appropriate box.

This transaction is for CCC
This transaction is for NRCS

OPTION AGREEMENT TO PURCHASE
AMENDMENT 1
2. OPTION AGREEMENT TO PURCHASE
CONTRACT NO.

This Amendment revises the above referenced Option Agreement to Purchase executed on (3)
between the United States of America (hereafter “United States”), and the following named Landowner(s), their heirs,
successors and assigns (hereafter “Landowner”):
4. Landowner Name:
5. Landowner Address:

The following paragraphs of the Agreement are amended as follows:
2.

Subject to the terms of this Agreement, the United States will pay the Landowner (A) $
for
conveyance of the easement. The Landowner agrees to accept this amount as the full and final compensation for
the easement.

7.

This agreement is effective for (A)
months from the date of execution below. During that period, the
United States has the option to acquire the easement for the stated purchase price.

Reason for Amendment: Completion of a legal land survey provided a more accurate measurement of the easement
area. Easement area acres have changed from (6)
to (7)
. Compensation is adjusted
accordingly.
8. Executed this (A)

day of (B)

, (C)

9. Landowner(s)
10. Title
11. United States
12. Title

OMB DISCLOSURE STATEMENT
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 collections is 0578-0013. The time required to complete this information collection is estimated to
average 40 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 information.

The signature by the NRCS representative signifies a CCC or NRCS
transaction as indicated above.

AD-1157A
rev.

OMB No. 0578-0013

OPTION AGREEMENT TO PURCHASE
CONTRACT NO.

NONDISCRIMINATION STATEMENT
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its program 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, SW., Washington, DC
20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and
employer.

PRIVACY ACT STATEMENT
The above statements are made in accordance with the Privacy Act of 1974 (5 U.S.C. 522a). Furnishing this information
is voluntary; however, failure to furnish correct, complete information will result in the withholding or withdrawal of
such technical or financial assistance. The information may be furnished to other USDA agencies, the Internal Revenue
Service, the Department of Justice, or other State or Federal law enforcement agencies, or in response to orders of a
court, magistrate, or administrative tribunal.

OMB No. 0578-0013

The signature by the NRCS representative signifies a CCC or NRCS
transaction as indicated above.

AD-1157A
rev.