FSA-211 and 211A Power of Attorney and Continution

This form is available electronically.

FSA-211 (12-17-08)

U. S. DEPARTMENT OF AGRICULTURE Farm Service Agency – Natural Resources Conservation Service - Commodity Credit Corporation - Federal Crop Insurance Corporation – Risk Management Agency POWER OF ATTORNEY

THE UNDERSIGNED does hereby appoint the following grantee:

(1)

     

of the following address: (2)

     

     

in the county of: (3)

     

in the State of:

(4)

     

the attorney-in-fact for (5)

     

(insert grantor’s name) in connection with the Farm Service Agency, Natural Resources Conservation Service Agency, or Commodity Credit Corporation programs checked below. NOTE: This power of attorney form is not valid for FSA Farm Loan Program purposes.

A. FSA, NRCS and CCC PROGRAMS (Check applicable programs)

TRANSACTIONS for FSA, NRCS, and CCC PROGRAMS (Check applicable actions)

1. All current programs.

10. Noninsured Crop Disaster Assistance Program.

1. All actions.

2. All current and all future programs.

11. Marketing Assistance Loans and Loan Deficiency Payments.

2. Signing applications, agreements, and contracts.

3. Direct and Counter-Cyclical Program.

12. Milk Income Loss Contract Program.

3. Making reports.

4. Average Crop Revenue Election Program.

13. Farm Storage Facility Loan Program.

4. Conducting all marketing assistance loan and LDP transactions.

5. Supplemental Revenue Assistance Payments Program (SURE).

14. FSA Conservation Programs.

5. AGI Certification.

6. Tree Assistance Program (TAP).

15. NRCS Conservation Programs.

6. Routing Banking Accounts.

7. Livestock Indemnity Program (LIP).

16. Tobacco Programs.

7. Other (Specify):

8. Livestock Forage Disaster Program (LFP).

17. Other (Specify):

     

9. Emergency Assistance for Livestock Honey Bees, and Farm-Raised Fish (ELAP).

     

This form may also be used to grant authority to an attorney-in-fact to act on the grantor’s behalf with respect to FCIC crop insurance policies. Checking any of the FCIC transactions does not have any impact as to the FSA, NRCS or CCC transactions checked above:

C. INSURED CROPS/STATE/COUNTY (Enter “All” or specify each crop, state, county and year(s))

D. CROP INSURANCE TRANSACTIONS (Check applicable actions)

1.

     

1. All actions.

5. Making transfers and cancellations.

2.

     

2. Making applications for insurance.

6. Making contract changes.

3.

     

3. Reporting crop acreage and production reports.

7. Other (Specify):

4.

     

4. Reporting a notice of damage or loss and making claim for indemnity.

     

This Power of Attorney is valid in all counties in the United States unless otherwise noted. This power of attorney shall remain in full force and effect until (1) written notice of its revocation has been duly served upon FSA, NRCS or CCC as appropriate; (2) death of the undersigned grantor; or (3) incompetence or incapacitation of the undersigned grantor. The undersigned grantor shall provide separate written notice of revocation to the applicable crop insurance agent. This power of attorney shall not be effective until properly executed and served to a USDA Service Center.

AUTHORIZED SIGNATURES

6A. Signature of Grantor (Individual)

6B. Signature Date (MM-DD-YYYY)      

6C. For Grantor’s Signature Continuation, check here if FSA-211A is attached.

7A. Signature of Grantor (Partnership, Corporation, Trust, etc.) (By)

7B. Title/Relationship of Individual Signing in the Representative Capacity      

7C. Signature Date (MM-DD-YYYY(      

8. Notary Public (this form shall be acknowledged by a notary Public unless witnessed by a FSA employee or a corporate seal of grantor is affixed).

Signature (a)

the state of (b)

     

the County of (c)

     

FOR FSA USE ONLY

9A. Witness Signature (FSA Employee Only)

9B. Signature Date (MM-DD-YYYY)

9C. Official Position

     

     

10. This power of attorney was served to (a)

     

USDA Service Center,

State of (b)

     

and became effective this (c)

     

day of (d)

     

, (e)

     

.

NOTE:

The primary authority for requesting and safeguarding the information described on this form is the Food, Conservation, and Energy Act of 2008 (Pub. L. 110-246 and any amendments to such act as may follow). The information requested is necessary for the authorized attorney-in-fact to act in a representative capacity for the undersigned grantor. Furnishing the requested information is voluntary. Failure to furnish the requested information will result in a determination of ineligibility for certain program benefits and other financial assistance administered by USDA. The information collected as a result of this form may be released to USDA employees, USDA contractors, or authorized USDA cooperators who are bound to safeguard the information under Section 1619 of the Food, Conservation and Energy Act, the Privacy Act of 1974, the E-Government Act of 2002, and related authorities. The information collection is exempted from the Paperwork Reduction Act, as it is required for the administration of the Food, Conservation, and Energy Act of 2008 (see Pub. L. 110-246, Title I, Subtitle, Subtitle F - Administration and Title II, Subtitle J – Administration). The provisions of criminal, civil, and privacy statutes may be applicable to the information provided. RETURN THIS COMPLETED FORM TO THE APPLICABLE USDA SERVICE CENTER.

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.

This form is available electronically.

FSA-211A (12-17-08)

U. S. DEPARTMENT OF AGRICULTURE Farm Service Agency – Natural Resources Conservation Service - Commodity Credit Corporation - Federal Crop Insurance Corporation – Risk Management Agency POWER OF ATTORNEY SIGNATURE CONTINUATION SHEET

Attachment Pages

  

of

  

Attach to Form FSA-211

Note:

The primary authority for requesting and safeguarding the information described on this form is the Food, Conservation, and Energy Act of 2008 (Pub. L. 110-246 and any amendments to such act as may follow). The information requested is necessary for the authorized attorney-in-fact to act in a representative capacity for the undersigned grantor. Furnishing the requested information is voluntary. Failure to furnish the requested information will result in a determination of ineligibility for certain program benefits and other financial assistance administered by USDA. The information collected as a result of this form may be released to USDA employees, USDA contractors, or authorized USDA cooperators who are bound to safeguard the information under Section 1619 of the Food, Conservation and Energy Act, the Privacy Act of 1974, the E-Government Act of 2002, and related authorities. The information collection is exempted from the Paperwork Reduction Act, as it is required for the administration of the Food, Conservation, and Energy Act of 2008 (see Pub. L. 110-246, Title I, Subtitle, Subtitle F - Administration and Title II, Subtitle J – Administration). The provisions of criminal, civil, and privacy statutes may be applicable to the information provided. RETURN THIS COMPLETED FORM TO THE APPLICABLE USDA SERVICE CENTER.

1. Name of Attorney-In-Fact (Item (1) from FSA-211)      

2. Name of Grantor (Item (5) from FSA-211)      

AUTHORIZED SIDGNATURES

3A. Signature of Grantor (By)

3B. Title/Relationship of Individual Signing in the Representative Capacity      

3C. Signature Date      

3D. Witness Signature (FSA Employee Only)

3E. Signature Date      

3F. Official Position      

3G. Notary Public (this form shall be acknowledged by a Notary Public unless witnessed by a FSA employee or a corporate seal of grantor is affixed).

Signature:

the State of

     

the County of

     

4A. Signature of Grantor (By)

4B. Title/Relationship of Individual Signing in the Representative Capacity      

4C. Signature Date      

4D. Witness Signature (FSA Employee Only)

4E. Signature Date      

4F. Official Position      

4G. Notary Public (this form shall be acknowledged by a Notary Public unless witnessed by a FSA employee or a corporate seal of grantor is affixed).

Signature:

the State of

     

the County of

     

5A. Signature of Grantor (By)

5B. Title/Relationship of Individual Signing in the Representative Capacity      

5C. Signature Date      

5D. Witness Signature (FSA Employee Only)

5E. Signature Date      

5F. Official Position      

5G. Notary Public (this form shall be acknowledged by a Notary Public unless witnessed by a FSA employee or a corporate seal of grantor is affixed).

Signature:

the State of

     

the County of

     

6A. Signature of Grantor (By)

6B. Title/Relationship of Individual Signing in the Representative Capacity      

6C. Signature Date      

6D. Witness Signature (FSA Employee Only)

6E. Signature Date      

6F. Official Position      

6G. Notary Public (this form shall be acknowledged by a Notary Public unless witnessed by a FSA employee or a corporate seal of grantor is affixed).

Signature:

the State of

     

the County of

     

7A. Signature of Grantor (By)

7B. Title/Relationship of Individual Signing in the Representative Capacity      

7C. Signature Date      

7D. Witness Signature (FSA Employee Only)

7E. Signature Date      

7F. Official Position      

7G. Notary Public (this form shall be acknowledged by a Notary Public unless witnessed by a FSA employee or a corporate seal of grantor is affixed).

Signature:

the State of

     

the County of

     

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.