Fsa-2684 Land Contract Recapture Agreement

This form is available electronically.
FSA-2684
(01-13-12)

Form Approved - OMB No. 0560-0279
Position 2

U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency

LAND CONTRACT RECAPTURE AGREEMENT
This agreement made this (1)

day of (2)

, (3)

, is entered into between
(hereinafter called ³Seller´) and
the United States of America acting through the Farm Service Agency of the U.S. Department of Agriculture (hereinafter called ³Agency´).
Agency has paid a loss claim on the Land Contract of the Seller under the Standard Guarantee Plan, copy of which is attached as Attachment
A and incorporated hereto. The Seller has chosen the appraisal method of payment rather than liquidation, and is retaining the property after
, five years from the date of the loss claim payment.
liquidation. This agreement will expire on (5)
(4)

This agreement is secured by the following security instrument, given in exchange for payment of the loss claim:
6.

7.

8.

9.

10.

Date of Security
Instrument

Records of County

State

Filing Information
(Book, Page, Reel, etc.)

Grantor

Based on the appraisal the value of the property is (11) $
, and the amount of the loss claim paid to the
seller was (12) $
.
In consideration of Agency making the loss claim payment, Seller agrees to give the Agency alien on the security property in the amount of
the loss claim payment and to pay to the Agency any increase in market value (appreciation) above the appraisal value listed above, if the
real estate is conveyed before the expiration of the 5 year period.
The total amount of recapture due Agency from the seller will never exceed the amount of the loss claim that was paid.
13. Seller¶s Signature
14. Authorized Agency Official Name

15. Authorized Agency Official Title

16. Signature of Authorized Agency Official
NOTE:

The following statement is made in accordance with the Privacy Act of 1974 (5 U.S.C. 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 0560-0279. The time required to complete this information collection is estimated to average 15
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.

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.