7-21EXINAQ Attachment Sheet for Form 7-21XS

OMB CONTROL NO.: 1006-0005

FORM 7-21XSINAQ
2012
(7-11)

ATTACHMENT SHEET FOR FORM 7-21XS
(IDENTIFICATION OF INVOLUNTARILY ACQUIRED LAND)
[Required Information for Item 11(d) of Form 7-21XS]
For Certification and Reporting Requirements of the Reclamation
Reform Act of 1982

BUREAU OF RECLAMATION

Do not use this form after December 31, 2012. Separate instructions for the completion of this form are on the reverse side of this page. You may use this attachment sheet to provide required information if
you involuntarily acquired eligible land and designated that land as excess, or you may use your own similar attachment sheet. Type or print in ink. Date and initial crossouts and corrections. Use as many of
these attachment sheets as necessary. Visit www.usbr.gov/rra for more information.

LANDHOLDER NAME:
INVOLUNTARILY ACQUIRED ELIGIBLE LAND DESIGNATED AS EXCESS

(1)
Legal Description of Land Parcel or
Assessor’s Parcel Number

(2)
Name of the Landholder
From Whom Each Parcel Was
Involuntarily Acquired

(3)
Date Each Parcel
Was Involuntarily
Acquired
(m/d/yr)

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(4)
Status of the Parcel
When It Was
Involuntarily Acquired

(5)
(6)
If the Land Was
Acreage Limitation
Excess When It Was
Status of the
Involuntarily Acquired,
Landholder From
Why Is the
Whom the
Land Eligible to Receive
Land Was
Reclamation Irrigation
Involuntarily Acquired
Water?

(7)
Water Rate
Applicable for
Reclamation
Irrigation Water
Delivered To the
Previous Landholder