Representation for CCC and FSA Loans and Authorization to File a Financing Statement

Instructions For CCC-10

Representations for CCC or FSA Loans and Authorization to File a Financing Statement and Related Documents

Applicants for CCC marketing assistance loans use this form to make certain representations to CCC in order to obtain loans. For FSA Farm Loan Programs, the form is used only when an individual, who has not signed the FSA-410-1 loan application, is pledging security for a loan.

Submit the original completed form in hard copy or a facsimile copy to the appropriate county FSA office, cotton Loan Servicing Agent, or peanut Designated Marketing Association.

Producers must complete Items 1 through 9.

Items 1-9

Fld Name/ Item No.	Instruction
Part A Introduction	Please read the statements in this part. If you have questions, contact your appropriate FSA servicing office, cotton Loan Servicing Agent, or peanut Designated Marketing Association.
Part B Representa- tion of Undersigned	Enter information for undersigned in Items 1 through 8.
1 Type of Undersigned	Check the box for individual if you conduct your farming operation as an individual. Check the box for organization or entity if you conduct your farming operation as an organization or entity.
2 Social Security or Tax Identification Number	If you checked the box in Item 1 for individual, enter your Social Security Number. If you checked the box in Item 1 for organization or entity, enter the applicable tax identification number.

Fld Name/ Item No.	Instruction
3 Undersigned’s Full Legal Name	If you checked the box in Item 1 for individual, enter your first, middle, last name and, if applicable, a suffix. If you checked the box in Item 1 for organization or entity, enter the full legal name of the organization or entity.
4 Spouse’s Full Legal Name	If you checked the box in Item 1 for individual, enter the first, middle, last name and, if applicable, a suffix for your spouse.
5 State and County of Primary Residence if Undersigned is an Individual	If you checked the box in Item 1 for individual, enter the name of the State and county of your primary residence.
6 If Undersigned is an Organization or Entity	If you checked the box in Item 1 for organization or entity, enter the type of organization or entity. Acceptable types are corporations, general or limited partnerships, limited liability companies, and trusts. An informal joint operation or venture is not a legal entity. Members of an informal joint operation or venture are treated as individuals.
7 If Undersigned is a Registered Organization or Entity	If the organization or entity is registered, it must be organized under the law of a single State and must be displayed in a State public record as being organized. If the organization or entity is registered, enter the state in which the organization or entity was created and is registered.
8 If Undersigned is a Non-Registered Organization or Entity	If the organization or entity is not registered, enter the State where the place of business is located or where the organization or entity conducts its affairs.
Part C Authorization To File 9 The Undersigned authorizes…	Read the statement in Item 9. If you have questions, contact your appropriate FSA servicing office, cotton Loan Servicing Agent, or peanut Designated Marketing Association.
9A-9D Signature of Undersigned and date	If you checked the box in Item 1 for individual, enter your signature as first, middle, last name and, if applicable, a suffix, and add the date of signature. If you checked the box in Item 1 for organization or entity, enter the legal name of the organization or entity, the word “by”, your signature, your title, and add the date of signature. Example: Hobbitt Farms by John H. Smith, partner