Form FSA-2141 Interest Bearing Deposit Agreement

Form Approved - OMB No. 0560-0238
(See Page 2 for Privacy Act and Public Burden Statements)
U.S. DEPARTMENT OF AGRICULTURE
Position 2
Farm Service Agency

This form is available electronically.

FSA-2141
(12-31-07)

INTEREST-BEARING DEPOSIT AGREEMENT

BECAUSE certain funds of (1)

referred to

as the "Depositor," are now on deposit with (2)
referred to as the "Financial Institution," under a Deposit Agreement dated (3)

, providing for

supervision by the United States of America, acting through the Farm Service Agency, referred to as the "Government,"
which Deposit Agreement grants to the Government security and/or other interest in the funds covered by the Deposit
Agreement, and
BECAUSE certain of these funds are not now required for immediate disbursement and it is the desire of the
Depositor to place these funds in interest-bearing deposits with the Financial Institution:
THEREFORE, the Depositor and the Government authorize and direct the Financial Institution to place
(4)

Dollars ($

)

of the funds subject to that Deposit Agreement in interest-bearing deposits as follows:

$

for a period of

months at

% interest

(b) $

for a period of

months at

% interest

(c) $

for a period of

months at

% interest

(a)

These interest bearing deposits and the income earned on them at all times shall be considered a part of the account covered
by said Deposit Agreement, except that the right of the Depositor and the Government to jointly withdraw all or a portion of
the funds in the account covered by the Deposit Agreement by an order of the Depositor countersigned by a representative of
the Government, and the right of the Government to make written demand for the balance or any portion of the balance, is
modified by the above time deposit maturity schedule. The evidence of such time deposits shall be issued in the names of the
Depositor and the Farm Service Agency.

FSA-2141 (12-31-07)

Page 2

A copy of this Agreement shall be attached to and become a part of each certificate, passbook, or other evidence of deposit
that may be issued to represent such interest-bearing deposits.
5A. Name of Financial Institution's Representative

5B. Title

5C. Signature

5D. Date

6A. Name of FSA's Representative

6B. Title

6C. Signature

6D. Date

7A. Depositor's Signature

7B. Date

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 (FOIA), 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 0560-0238. The time
required to complete this information collection is estimated to average 10 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.
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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.