Form 7-2190 Report of Individual's Landholdings

OMB CONTROL NO.: 1006-0005

FORM 7-2190
2014

Districts must complete the “District Name” and “Date Received” boxes.

REPORT OF INDIVIDUAL'S LANDHOLDINGS
(Prior Law Provisions)

District Name:
DATE RECEIVED:

(7-13)
BUREAU OF RECLAMATION

Do not use this form after December 31, 2014. It is important that you read the separate instructions that accompany this form before completing it. If you did not receive these
instructions, please contact your district office. Type or print in ink. Date and initial crossouts and corrections. Visit www.usbr.gov/rra for more information.

LANDHOLDER INFORMATION
1.

Landholder name:

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2(b). If you responded “widowed” to item 2(a), as the surviving spouse, were you left with more
than 160 acres of land that is eligible to receive Reclamation irrigation water until it is sold?

2(a). Marital status:

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Yes

No

2(c). Number of acres held prior to death of spouse:

3.

Spouse name:

4(a). Landholder’s street address or rural route number, city, state, and ZIP code:

4(b). Mailing adress if different from street address:

5(a). Telephone number where questions can be directed: (
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5(b). Contact person:
6(a). List all entities in which you, your spouse if you are married, and/or your dependents own 100-percent interest. If you own 100-percent interest in an entity (including a
prior law corporation) that directly owns or leases land, list the entity here. All prior law corporations must complete Form 7-2191. Do not list trusts and estates of which you are
a beneficiary. Instead, list such trusts and estates in item 15. For purposes of determining total landholdings, land listed here must be listed again in the appropriate section of this
form. All trusts and estates must complete Form 7-21TRUST. For additional space, use attachments.
(1) Entity Name

(2) Employer
Identification Number

(3) Entity Type

(4) State(s) or
Country(ies)
(where established)

(5) Legal Description or Assessor’s Parcel (6) Number of
Acres
Number

(7) Status
Prior Law

Discretionary

6(b). List the names of your dependents if they hold land in their own names, or any other names in which you or your spouse, if married, may directly hold land. Do not list land your
dependents hold indirectly through an entity or a trust. Instead, list such land in item 15. For purposes of determining total landholdings, land listed here must also be listed again
in the appropriate section of this form. For additional space, use attachments.
(1) Dependent(s) or Other Names in Which
You or Your Spouse Hold Land

7.

(2) Legal Description or Assessor’s Parcel Number

Check the box that indicates your citizenship status. If you are a nonresident alien, also
enter the country of which you are a citizen.

Self
U.S. Citizen
Resident Alien
Nonresident Alien

8.

Are you claimed as a dependent within the meaning of the Internal Revenue Code?
(Dependents must be included on their parents’ or legal guardians’ Form 7-2190.)
1

□

Yes

□

No

Spouse

(3) Number of
Acres

Country of Citizenship

FORM 7-2190 (2014)
9. LANDHOLDER’S NAME:
10.

LAND YOU DIRECTLY OWN

List all irrigable and/or irrigation land parcels westwide that are 100-percent owned by you. Include land directly owned by any entity in which you own 100-percent interest. Include land you lease from a
public entity here instead of including it under item 13. Identify such land as leased from a public entity and include the name of that public entity after the legal description of the land. For additional
space, use Form 7-21CONT-O or your own similar continuation sheet.

Other

Lessee/
Sublessee

(There is space to list four different parcels
[one parcel per line] if they all are operated by the
same natural person or entity in the same district.)

(c)
Operated by:
(check one)

Self

(a)
District Name

(b)
Legal Description of Land Parcel(s) or
Assessor's Parcel Number(s)

Lease Information
(d)
Identification of the Lessee, Sublessee, or Other Operator

(e)
Starting Date
(m/d/yr)

(f)
Ending Date
(m/d/yr)

Name:

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Address:

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11.

TOTAL NUMBER OF ACRES YOU DIRECTLY OWN
2

(g)
Number of Acres

(h)
Was Land
Acquired After
12/06/79?
YES

NO

FORM 7-2190 (2014)
12. LANDHOLDER’S NAME:
13.

LAND YOU DIRECTLY LEASE FROM ANOTHER PARTY
List all irrigable and/or irrigation land parcels westwide that you lease from another party. Include land directly leased by any entity in which you own 100-percent interest. Include the sublessor’s
name and the landowner’s name in column (d) if you sublease from a sublessor. Include the farm operator's name in column (d) if the land is operated by a farm operator. You must complete all
columns except column (g) if you sublease land parcels to others and provide the sublessee’s name and the landowner’s name in column (d). Do not include land you lease from a public entity here.
Such land needs to be included under item 10. For additional space, use Form 7-21CONT-L or your own similar continuation sheet.

Other

(c) Operated by:
(check one)
Self

(a)
District Name

(b)
Legal Description of Land Parcel(s) or
Assessor's Parcel Number(s)

(d)
Landowner’s Name
(If the land has been subleased or is
operated by a farm operator, see the
above instructions for other needed names.)

Lease Information
(e)
Starting Date
(m/d/yr)

(f)
Ending Date
(m/d/yr)

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(g)
Number of
Acres

TOTAL NUMBER OF ACRES YOU DIRECTLY LEASE

14.
15.

LAND YOU INDIRECTLY OWN OR LEASE THROUGH OTHER ENTITIES
List all entities that hold irrigable and/or irrigation land in which you own a part (less than 100-percent) interest and all trusts and estates in which you own up to and including 100-percent interest. Do
not include land directly held by any entity in which you own 100-percent interest. Instead, include that land in item 10 or item 13 as appropriate. Include land indirectly held by your dependents
and land indirectly held by any entity in which you own 100-percent interest. You will have to enter an entity’s name on more than one line if it holds irrigable and/or irrigation land in more than one
district. Obtain a copy of the entity’s completed Form 7-2181 or Form 7-2191, or a copy of the trust’s or estate’s completed Form 7-21TRUST to ensure the accuracy of the information you provide.
For additional space, use Form 7-21CONT-I or your own similar continuation sheet.

(a)
District Name

16.
17.

(b)
Name of Entity

(c)
Entity Employer
Identification Number

(h)
(f)
(i)
Double-Counting
(d)
(e)
(g)
Owned
Leased
Adjustments
Percentage of
Number of
Number of
Acreage
Acreage
Interest You
Acres Owned Attributable to Acres Leased
Attributable
(1)
(2)
Own in Each by the Entity in Your Interest in by the Entity in
to Your
Owned Acres Adjusted Acres
Each District
the Entity
Each District
Entity
Interest in
in (g)
[g minus h(1)]
(d X e)
the Entity

TOTAL NUMBER OF ACRES YOU INDIRECTLY OWN
TOTAL NUMBER OF ACRES YOU INDIRECTLY LEASE
3

(j)
Was Owned Land
Acquired After
12/06/79?

YES

NO

FORM 7-2190 (2014)
18. LANDHOLDER’S NAME:
LANDHOLDINGS SUMMARY
Circle the district at which the original form is filed if you are a multidistrict landholder.

19. DISTRICT NAME(S):

TOTAL

20. Total directly owned acres:
21. Total indirectly owned acres:
22. Total owned acres (item 20 plus item 21):

*

23. Total directly leased acres:
24. Total indirectly leased acres:
25. Total leased acres (item 23 plus item 24)
26. Total owned and leased acres (item 22 plus item 25):

**
You need to complete Form 7-21XS if this total exceeds your ownership entitlement. If some of this land was designated as excess by the seller and you purchased it without
sales price approval by Reclamation, you must designate that land as excess on Form 7-21XS, even if you do not exceed your ownership entitlement. You must complete a
Form 7-21XS if you own any land designated as excess for any reason (for example, you designated involuntarily acquired land as excess).
** NOTE: You need to complete Form 7-21FC if this total exceeds your nonfull-cost entitlement AND you directly or indirectly lease land.
* NOTE:

27. Acreage limitation status – Please check all of the following boxes that apply to you:

□

I, my spouse, or we do(es) NOT hold and have NEVER held land directly in a district after that district conformed to the discretionary provisions. (Not applicable to nonresident aliens or spouses who are both
nonresident aliens.)

□ I, my spouse, or we have (has) NEVER submitted an irrevocable election to conform to the discretionary provisions.
my spouse, or we only indirectly hold(s) or held land in a district after that district conformed to the discretionary provisions and I, my spouse, or we have NEVER submitted a “Certification of Individual’s
□ I,Landholding”
(Form 7-2180) to that district. (Not applicable to nonresident aliens or spouses who are both nonresident aliens.)
□ I, or my spouse have (has) NEVER been married to a person who was subject to the discretionary provisions.

28.

SIGNATURE(S)
Your spouse must sign this form if you are married. This requirement applies even if the land is not jointly held. You may use a written spousal signature authorization to permit one spouse to sign for the
couple.

Attention: This report must be signed and dated. Read the following
paragraphs before signing.
Under the provisions of 18 U.S.C. 1001, it is a crime punishable by 5 years
imprisonment or a fine of up to $10,000, or both, for any person to knowingly and
willfully submit or cause to be submitted to any agency of the United States any false
or fraudulent statement(s) as to any matter within the agency’s jurisdiction. False
statements by the landowner or lessee will also result in loss of eligibility. Eligibility
can only be regained upon the approval of the Commissioner.
I (we) attest that the information provided herein is true, accurate, and complete to
the best of my (our) knowledge and agree that any change in the landholdings
information contained in this report will be provided verbally to all districts named
within 30 calendar days of such change, and that new forms will be submitted
within 60 calendar days of such change. I (we) further attest that any leases of land
receiving irrigation water to which I am (we are) a party are in writing and have terms
that do not exceed 10 years, except perennial crops leases which cannot exceed
25 years and must have written approval from the Bureau of Reclamation. I (we)
also attest that all landholdings of both spouses, if married, and any dependents (if
applicable), whether held directly or indirectly, have been identified on this form.

Landholder’s Signature

Date

Spouse’s Signature

Date

This report is required by Public Law 97-293. Failure to report can result in prosecution and/or loss of water deliveries from Federal reclamation projects. Information obtained in this report is protected by the Privacy Act of 1974, system of
records notice INTERIOR/WBR-31, and will be used to administer the acreage limitation provisions of Federal reclamation law. The Secretary of the Interior or the district may require additional information in order to administer these laws.
The Secretary may also require a copy of your lease(s).

PLEASE RETURN THIS FORM TO THE APPROPRIATE DISTRICT OFFICE(S).
4

OMB CONTROL NO.: 1006-0005

CONTINUATION SHEET FOR DIRECTLY OWNED LAND
For Certification and Reporting Requirements of the
Reclamation Reform Act of 1982

FORM 7-21CONT-O
2014
(7-13)
BUREAU OF RECLAMATION

Do not use this form after December 31, 2014. Refer to the instructions of the form for which you are preparing this continuation sheet. You may use this continuation sheet for additional space when listing directly
owned land, or you may use your own similar continuation sheet. Type or print in ink. Date and initial crossouts and corrections. Only landholders subject to prior law provisions should complete column (h). Use
as many of these continuation sheets as necessary. Visit www.usbr.gov/rra for more information.

LANDHOLDER NAME(S):
THIS FORM IS A CONTINUATION OF FORM 7-21__________________ DATED _______________________
LAND THE LANDHOLDER DIRECTLY OWNS

Other

Lessee/
Sublessee

(There is space to list four different parcels
[one parcel per line] if they all are operated by the
same natural person or entity in the same district.)

(c)
Operated by:
(check one)
Self

(a)
District Name

(b)
Legal Description of Land Parcel(s) or
Assessor's Parcel Number(s)

Lease Information
(d)
Identification of the Lessee, Sublessee, or Other Operator

(e)
Starting Date
(m/d/yr)

(f)
Ending Date
(m/d/yr)

Name:

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Address:

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(g)
Number
of
Acres

(h)
PRIOR LAW
ONLY
Was Land
Acquired After
12/06/79?

YES

NO

FORM 7-21CONT-O (2014)
LANDHOLDER NAME(S):
THIS FORM IS A CONTINUATION OF FORM 7-21__________________ DATED _______________________
LAND THE LANDHOLDER DIRECTLY OWNS

Other

Lessee/
Sublessee

(There is space to list four different parcels
[one parcel per line] if they all are operated by the
same natural person or entity in the same district.)

(c)
Operated by:
(check one)
Self

(a)
District Name

(b)
Legal Description of Land Parcel(s) or
Assessor's Parcel Number(s)

Lease Information
(d)
Identification of the Lessee, Sublessee, or Other Operator

(e)
Starting Date
(m/d/yr)

(f)
Ending Date
(m/d/yr)

Name:

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Address:

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(g)
Number
of
Acres

(h)
PRIOR LAW
ONLY
Was Land
Acquired After
12/06/79?

YES

NO

OMB CONTROL NO.: 1006-0005

FORM 7-21CONT-L
2014

CONTINUATION SHEET FOR DIRECTLY LEASED LAND
For Certification and Reporting Requirements of the Reclamation Reform Act of 1982

(7-13)
BUREAU OF RECLAMATION

Do not use this form after December 31, 2014. Refer to the instructions of the form for which you are preparing this continuation sheet. You may use this continuation sheet for additional space when listing
directly leased land, or you may use your own similar continuation sheet. Type or print in ink. Date and initial crossouts and corrections. Use as many of these continuation sheets as necessary. Visit
www.usbr.gov/rra for more information.

LANDHOLDER NAME(S):
THIS FORM IS A CONTINUATION OF FORM 7-21__________________ DATED _______________________
LAND THE LANDHOLDER DIRECTLY LEASES FROM ANOTHER PARTY

Other

(c) Operated by:
(check one)
Self

(a)
District Name

(b)
Legal Description of Land Parcel(s) or
Assessor's Parcel Number(s)

(d)
Landowner’s Name
[If the land has been subleased or is
operated by a farm operator, see the
instructions to the form for other needed names.]

1

Lease Information
(e)
Starting Date
(m/d/yr)

(f)
Ending Date
(m/d/yr)

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(g)
Number of
Acres

FORM 7-21CONT-L (2014)
LANDHOLDER’S NAME:
THIS FORM IS A CONTINUATION OF FORM 7-21__________________ DATED _______________________
LAND THE LANDHOLDER DIRECTLY LEASES FROM ANOTHER PARTY

Other

(b)
Legal Description of Land Parcel(s) or
Assessor's Parcel Number(s)

Self

(a)
District Name

(c) Operated by:
(check one)

(d)
Landowner’s Name
[If the land has been subleased or is
operated by a farm operator, see the
instructions to the form for other needed names.]

2

Lease Information
(e)
Starting Date
(m/d/yr)

(f)
Ending Date
(m/d/yr)

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(g)
Number of
Acres

OMB CONTROL NO.: 1006-0005

CONTINUATION SHEET FOR INDIRECTLY HELD LAND
For Certification and Reporting Requirements of the Reclamation Reform Act of 1982

FORM 7-21CONT-I
2014
(7-13)
BUREAU OF RECLAMATION

Do not use this form after December 31, 2014. Refer to the instructions of the form for which you are preparing this continuation sheet. You may use this continuation sheet for additional space when listing indirectly held
land, or you may use your own similar continuation sheet. Type or print in ink. Date and initial crossouts and corrections. Only landholders subject to prior law provisions should complete column (j). Use as many of these
continuation sheets as necessary. Visit www.usbr.gov/rra for more information.

LANDHOLDER NAME(S):
THIS FORM IS A CONTINUATION OF FORM 7-21__________________ DATED _______________________
LAND THE LANDHOLDER INDIRECTLY HOLDS THROUGH OTHER ENTITIES

(a)
District Name

(b)
Name of Entity

(c)
Entity Employer
Identification Number

(f)
(d)
Owned
(e)
Percentage
Acreage
Number of
of Interest
Attributable to
Acres
the
the
Owned by
Landholder
Landholder’s
the Entity in
Owns in
Interest in the
Each District
Each Entity
Entity
(d X e)

1

(h)
(j)
(i)
Double-Counting
(g)
Leased
PRIOR
Adjustments
Number of
Acreage
LAW ONLY
Acres
Attributable to
Was Owned
(2)
Leased by
the
Land Acquired
(1)
Adjusted
the Entity in Owned Acres
Landholder’s After 12/06/79?
Acres
Each District
Interest in the
in (g)
[g minus h(1)]
Entity
YES
NO

FORM 7-21CONT-I (2014)
LANDHOLDER’S NAME:
THIS FORM IS A CONTINUATION OF FORM 7-21__________________ DATED _______________________
LAND THE LANDHOLDER INDIRECTLY HOLDS THROUGH OTHER ENTITIES

(a)
District Name

(b)
Name of Entity

(c)
Entity Employer
Identification Number

(d)
(e)
Percentage
Number of
of Interest
Acres
the
Owned by
Landholder
the Entity in
Owns in
Each District
Each Entity

2

(f)
Owned
Acreage
Attributable
to the
Landholder’s
Interest in the
Entity
(d X e)

(g)
Number of
Acres
Leased
by the Entity
in Each
District

(h)
Double-Counting
Adjustments
(1)
Owned
Acres
in (g)

(i)
Leased
Acreage
Attributable to
the
(2)
Landholder’s
Adjusted
Interest in the
Acres
Entity
[g minus h(1)]

(j)
PRIOR LAW
ONLY
Was Owned
Land Acquired
After 12/06/79?

YES

NO