FSA-2043 Assignment of dairy proceeds - applicant and purchaser

This form is available electronically.

Form Approved - OMB No. 0560-0237
(See Page 2 for the Privacy Act and Public Burden Statements)
Position 1

U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency

FSA-2043
(12-31-07)

ASSIGNMENT OF PROCEEDS FROM THE SALE OF DAIRY
PRODUCTS AND RELEASE OF SECURITY INTEREST
PART A - GENERAL
1. Name and Address of Seller

3. Name and Address of Purchaser

2. Seller's Telephone Number

4. Purchaser's Telephone Number

5. Effective Date of Assignment

6. Patron Account Number

PART B - SELLER AGREEMENT
1. In consideration of a loan made by the United States, acting through the U.S. Department of Agriculture, Farm Service Agency (FSA), the Seller
assigns and transfers to FSA the following percentages or amounts of the purchase price due or which may become due, to seller from the
Purchaser for dairy products sold, or which may be sold, to, by, or through Purchaser, as indicated below:
(a)
(c) $
price if less than that amount.

percent payable (b)
of purchase price, payable (d)

or full purchase

all proceeds from sales in excess of (e)
payable (f)
until FSA releases or suspends this assignment in writing, giving notice of that action to Purchaser. This assignment supersedes any previous
assignment to FSA of income due Seller from the above-named Purchaser.
2. Special Instructions

3. By signing below, the Seller directs and authorizes Purchaser to make and deliver payments.
3(a) Signature

3(b) Date

PART C - PURCHASER ACCEPTANCE (Continued on Page 2)
1. The undersigned consents to accept the above assignment and agrees to remit to FSA the sum of money provided in the assignment, when due
and payable under it. This assignment will be given priority over any subsequent assignments granted to other lenders. Payments will be
identified by the name and address of the Seller, Patron Account Number, or as otherwise agreed. If payment is made by check, the check will be
payable and delivered as provided below:
(a) To the order of the Farm Service Agency
(b) Jointly to the order of the Seller and the Farm Service Agency
(c) To the order 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.

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FSA-2043 (12-31-07)
PART C - PURCHASER ACCEPTANCE

2. As used in this assignment, "purchase price due or which may become due" means that amount which Purchaser owes or may owe Seller for the
sale to, by, or through Purchaser of dairy products after any deduction of the following codes:
1 - any amounts entitled to legal priority over this assignment.
2 - obligations of Seller in favor of Purchaser in connection with membership dues, commission of checkoff, expendable operating supplies,
and minor items of operating equipment (but not major capital items of equipment) furnished to the Seller and necessary for production of
dairy products whether such obligations arise or mature before or after the effective date of this assignment.
3 - revolving fund credits, patronage refunds, or per unit capital returns, allocated or paid by Purchaser to Seller before or after the effective
date of this assignment.
4 - payments made by or through Purchaser for transportation of said dairy products of members to market, regardless of the date of the
payment.
3. As of

, the Purchaser has accepted the following assignments of income due the Seller:
3(a)
Name

3(b)
Address

3(c)
Amount of Deduction

3(d)
Date of Assignment or
Prior Claim

3(e)
Deduction Priority Code

$

$
$
$

4. Name of Purchaser's Duly Authorized Representative

6. Signature

5. Title

7. Date

PART D - RELEASE OF SECURITY INTEREST
1. In consideration of the acceptance of this assignment by the above-named Purchaser, FSA hereby releases any lien or security interest it has or
may have in dairy products sold by the Seller to, by, or through Purchaser. This release is granted only to the extent the payments are made as
set forth above. In the event there are insufficient proceeds to meet said payments because of either prior authorized assignments or low
production by the Seller, the Purchaser will not be held liable for the difference for that planned payment.
2. Name of Agency Official
3. Title
4. Date

5. Signature

6. Address of FSA Office

NOTE: The following statements are made in accordance with the Privacy Act of 1974 (5 USC 552a): the Farm Service Agency (FSA) is authorized by the Consolidated
Farm and Rural Development Act, as amended (7 USC 1921 et seq.), or other Acts, and the regulations promulgated thereunder, to solicit the information
requested on its application forms. The information requested is necessary for FSA to determine eligibility for credit or other financial assistance, service your loan,
and conduct statistical analyses. Supplied information may be furnished to other Department of Agriculture agencies, the Internal Revenue Service, the
Department of Justice or other law enforcement agencies, the Department of Defense, the Department of Housing and Urban Development, the Department of
Labor, the United States Postal Service, or other Federal, State, or local agencies as required or permitted by law. In addition, information may be referred to
interested parties under the Freedom of Information Act, to financial consultants, advisors, lending institutions, packagers, agents, and private or commercial credit
sources, to collection or servicing contractors, to credit reporting agencies, to private attorneys under contract with FSA or the Department of Justice, to business
firms in the trade area that buy chattel or crops or sell them for commission, to Members of Congress or Congressional staff members, or to courts or adjudicative
bodies. Disclosure of the information requested is voluntary. However, failure to disclose certain items of information requested, including Social Security Number
or Federal Tax Identification Number, may result in a delay in the processing of an application or its rejection.
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 0560-0237. 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. RETURN THIS COMPLETED FORM TO YOUR COUNTY FSA
OFFICE.