FSA-2006 Property Owned and Leased

Land Contract Guarantee Program and Emergency Equine Loss Loan (EM) Program - Direct Loan Making

FSA2006_100323V01[1]

Land Contract Guarantee program and Emergency Equine Loss Loan (EM) Program - Direct Loan Making

OMB: 0560-0278

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Form Approved - OMB No. 0560-0237

This form is available electronically. (See Page 2 for the Privacy Act and the Public Burden Statements.)

FSA-2006

(03-23-10)

U.S. DEPARTMENT OF AGRICULTURE

Farm Service Agency

Position 3


PROPERTY OWNED AND LEASED

1. Name of Applicant

     


A. LAND. Include all land owned, to be owned, or leased.

1A. Owner of Record

     

1B. Description

     

1C. County

     

1D. Farm No.



     

1E. Total

Acres


     

1F. Crop Acres



     

1G. Oral/

Written

Lease

     

1H. Crop

Share


     

%

1I. Cash Rent

1J. Expiration Date


     

$

     

2A. Owner of Record

     


2B. Description

     

2C. County

     

2D. Farm No.



     

2E. Total

Acres


     

2F. Crop Acres



     

2G. Oral/

Written

Lease

     

2H. Crop

Share


     


2I. Cash Rent

2J. Expiration Date


     

%

$

     

3A. Owner of Record

     

3B. Description

     

3C. County

     

3D. Farm No.



     

3E. Total

Acres


     

3F. Crop Acres



     

3G. Oral/

Written

Lease

     

3H. Crop

Share


     

%

3I. Cash Rent

3J. Expiration Date


     

$

     

4A. Owner of Record

     

4B. Description

     

4C. County

     

4D. Farm No.



     

4E. Total

Acres


     

4F. Crop Acres



     

4G. Oral/

Written

Lease

     

4H. Crop

Share


     

%

4I. Cash Rent

4J. Expiration Date


     

$

     

5A. Owner of Record

     

5B. Description

     

5C. County

     

5D. Farm No.



     

5E. Total

Acres


     

5F. Crop Acres



     

5G. Oral/

Written

Lease

     

5H. Crop

Share


     


5I. Cash Rent

5J. Expiration Date






%

$

     

The U.S. Department of Agriculture (USDA) prohibits discrimination in all of 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, political beliefs, genetic information, 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, Assistant Secretary for Civil Rights, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, S.W., Stop 9410, Washington, DC  20250-9410, or call toll-free at (866) 632-9992 (English) or (800) 877-8339 (TDD) or (866) 377-8642 (English Federal-relay) or (800) 845-6136 (Spanish Federal-relay).  USDA is an equal opportunity provider and employer.


FSA-2006 (03-23-10) Page 2 of 2

B. EQUIPMENT/LIVESTOCK. Include only equipment/livestock to be purchased, currently leased, or to be leased.

1.

Owner of Record

2.

Description

3.

Number of

Units

4.

Rent

$

5.

Share

%

6.

Type of Lease

7.

Expiration Date

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

C. CERTIFICATION

I certify that the information provided is true, complete, and correct to the best of my knowledge and is provided in good faith. (Warning: Section 1001 of title 18, United States Code, provides for criminal penalties to those who provide false statements. If any information is found to be false or incomplete, such finding may be grounds for denial of the requested action.)

1. Signature

2. Date

     

NOTE:

The following is made in accordance with the Privacy Act of 1974 (5 USC 552a – as amended). The authority for requesting the information identified on this form is the Consolidated Farm and Rural Development Act, as amended (7 U.S.C. 1921 et. seq.). The information will be used to determine eligibility and feasibility for loans and loan guarantees, and servicing of loans and loan guarantees. The information collected on this form may be disclosed to other Federal, State, and local government agencies, Tribal agencies, and nongovernmental entities that have been authorized access to the information by statute or regulation and/or as described in the applicable Routine Uses identified in the System of Records Notice for USDA/FSA-14, Applicant/Borrower. Providing the requested information is voluntary. However, failure to furnish the requested information may result in a denial for loans and loan guarantees, and servicing of loans and loan guarantees. The provisions of criminal and civil fraud, privacy, and other statutes may be applicable to the information provided.


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 30 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.



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleForm Approved - OMB No
AuthorJoanne.shaw
File Modified0000-00-00
File Created2021-01-30

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