LANDLORD
OR LANDOWNER EXEMPTION REQUEST
Landlords or landowners use
this form to request an exemption for conservation provisions under USDA
programs.
Submit the original of the
completed form in hard copy or facsimile to the appropriate FSA servicing
office.
Customers
who have established electronic access credentials with USDA may electronically
transmit this form to the USDA servicing office, provided that (1) the
customer submitting the form is the only person required to sign the
transaction, or (2) the customer has an approved Power of Attorney (Form
FSA-211) on file with USDA to sign for other customers for the program and type
of transaction represented by this form.
Features
for transmitting the form electronically are available to those customers with
access credentials only. If you
would like to establish online access credentials with USDA, follow the
instructions provided at the USDA eForms web
site.
Landlords
must complete Items 1 through 8.
Items 1 - 8
|
Fld. Name/ Item
No. |
Instruction |
|
1A State
Name |
Enter the State name
where the farm is located. |
|
1B |
Enter the County name
where the farm is located. |
|
2 Landlord or Landowner
Information |
Enter the landlord or
landowner�s name and address including Zip
code. |
|
3 Landlord or
Landowner's Telephone Number |
Enter the landlord or
landowner�s telephone number including area
code. |
|
4 Landlord or Landowner's Identification Number |
Enter the landlord or
landowner�s social security number or tax ID
number. |
|
5A Farm
Number |
Enter the Farm Number
on which the exemption request is being made. |
|
5B Tract
Number |
Enter the tract number
for which the exemption is requested. |
|
| |
|
6 Crop
Year |
Enter the crop year
for which the exemption request is being made. |
|
7 Cropland |
Enter the number of
acres for which the exemption request is being
made. |
|
8 Certification |
Enter landlord or
landowner�s signature and date. If you are mailing or
faxing this form, print the form and manually enter your signature. If
this form is approved for electronic transmission and you have established
credentials with USDA to submit forms electronically, use the buttons
provided on the form for transmitting the form to the USDA servicing
office. |
Items 9 - 10 are for FSA's use only.