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CRANBERRY MARKETING COMMITTEE
219A Main Street
Wareham, MA  02571
Phone: (508) 291-1510
Fax: (508) 291-1511
LEASED ACREAGE FORM
20__ CROP YEAR

Complete and return this form to the Cranberry Marketing Committee.
	
LEASED FROM: Lessor	Grower No. _________________
Name: 	
Business Name (or D/B/A): 	
Address:	
Telephone No.: 	

LEASED TO: Lessee	Grower No. _________________
Name: 	
Business Name (or D/B/A): 	
Address:	
Telephone No.: 	
	
LEASE INFORMATION AND TERMS
If this is a total lease of the Lessor’s owned acreage, complete 1(a) through (d).  If this is a partial lease, complete 2(a) through (e).

    1. TOTAL lease of Lessor’s owned acreage
    a) How many acres are being leased?  ________ acres.
    b) What is the length of this lease?  _____________ years.
    c) On what date did this lease commence?  ______________________ (day/month/year)
    d) On what date will this lease terminate?  ______________________ (day/month/year)
Note: All production history associated with the acreage being leased will be transferred to the Lessee.

    2. PARTIAL lease of Lessor’s owned acreage
    a) How many acres are being leased?  ________ acres.
    b) What is the length of this lease?  _____________ years.
    c) On what date did this lease commence?  ______________________ (day/month/year)
    d) On what date will this lease terminate?  ______________________ (day/month/year)
    e) Indicate the amount of sales history being conveyed (transferred) along with the leased acreage for each of the crop years shown below.  Note: Prior crop years’ sales history attributable to the acreage being leased must be transferred.
Crop Year
20___
20___
20___
20___
20___
20___
Sales History







I hereby certify that to the best of my knowledge, the information contained herein is true and accurate.

Lessor’s signature ________________________________		Date __________________

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 0581-0189.  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.  

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.