FS-2700-28 Request for New Appraisal (CUFFA)

Authorization ID: USDA Forest Service

Expiration Date: OMB No. 0596-0082 (expires 5/31/2009)

Use Code: 123-Recreation Residences FS-2700-28 (Rev. 11/2008)

Holder Name:

Statement from Holders Requesting a New Appraisal When Previous

Appraisal Indicated a Base Fee Increase of More Than $3,000 from Annual

Fee Assessed on October 1, 1996

We hereby request and agree that, if the new base fee established by the new appraisal results in an amount that is 90 percent or more of the fee determined by the previously completed appraisal of this typical lot (specifically, that appraisal dated ¹, with an estimated fee simple value of $ , and an indicated annual fee of $ ), each of the permit holders within this group of recreation residence __________________________________________² shall be obligated to pay to the United States the following:

1. The base fee that shall be established using the results of the new appraisal being requested, subject to the phase-in provisions of §609 of CUFFA; and

2. The difference between (a) the annual fee that was paid during calendar years ³, , , and ending with calendar year ⁴, and (b) the amount that the annual fee for each of those identified calendar years would otherwise have been had a new base fee been assessed as a result of the above-referenced appraisal, pursuant to the phase-in provisions in effect and applicable during that time.

We agree that the cumulative difference resulting from the application of Item #2 (above) shall be assessed as a premium fee amount, payable in full or in three (3) equal annual installments, in addition to the phase-in of the new base user fee established by the results of the new appraisal.

(This statement must accompany the request to conduct a new appraisal when previous appraisal indicated a base fee increase of more than $3,000 from annual fee assessed on October 1, 1996)

To Be Provided by the Forest Service:

1. Enter the date of the appraisal report, the estimated fee simple value, and an indicated fee.

2. Indicate tract name and lots.

3. Enter each calendar year beginning with that year when a new base fee based upon the above-referenced appraisal would have otherwise been implemented.

4. Enter the calendar year the request for a new appraisal is made.

(Signatures must represent a majority of the recreation residence holders within the group of recreation residences represented by this typical lot. Please use pg. 2 of this form to include any additional signatures).

Signatures: Date:

___________________________________ ___________________________

___________________________________ ___________________________

___________________________________ ___________________________

___________________________________ ___________________________

Please insert any additional signatures below:

BURDEN AND NONDISCRIMINATION STATEMENTS

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 0596-0082. The time required to complete this information collection is estimated to average 15 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.

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. (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 USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call toll free (866) 632-9992 (voice). TDD users can contact USDA through local relay or the Federal relay at (800) 877-8339 (TDD) or (866) 377-8642 (relay voice). USDA is an equal opportunity provider and employer.

The Privacy Act of 1974 (5 U.S.C. 552a) and the Freedom of Information Act (5 U.S.C. 552) govern the confidentiality to be provided for information received by the Forest Service.