7-21SUMM-C 2016 District Summary of Certification and Declaration Forms

OMB CONTROL NO.: 1006-0006

FORM 7-21SUMM-C
2016

DISTRICT SUMMARY OF CERTIFICATION
AND DECLARATION FORMS

1. District Name:

2. Total number of pages
including this page:

3. Project, unit, and/or division name:

4. Region:

(7-15)
BUREAU OF RECLAMATION

Do not use this form after December 31, 2016. Type or print in ink. Date and initial crossouts and corrections. Visit www.usbr.gov/rra for more information.

□1

5(a). District’s forms submittal category for the 2016 water year (check one):

5(b). Does the District anticipate delivering Reclamation irrigation water this year? (check one):
(a)
Number of
Landholders

Acreage Directly
Owned
(b) Number

6.

(c) Acres

□

2

□ YES

□

NO

Acreage Directly Leased
FROM Other Parties
(d) Number

(e) Acres

Directly Owned
Excess Acreage
(f) Number

(g) Acres

Directly Held
Full-Cost Acreage
(h) Number

(i) Acres

Individuals and entities (Tabulation A )
Qualified recipients 240 through 960
(For districts with forms submittal category 1 only)

Qualified recipients 80 through 960
(For districts with forms submittal category 2 only)

Qualified recipients over 960
Limited recipients 40 through 320
Limited recipients over 320 through 640
Limited recipients over 640
7.

Trusts and estates (Tabulation B )
Over RRA forms submittal threshold through 960
Over 960

8.

Public entities (Tabulation C )

9.

Religious and charitable organizations
(Tabulation D )
Noncertifying landholdings over RRA forms submittal
threshold (Tabulation E )
Total landholdings over RRA forms
submittal threshold (items 6-10)
Estimated landholdings below
RRA forms submittal threshold

10.
11.
12.
13.

Grand total (items 11 and 12)

14.

I ATTEST THAT THIS INFORMATION IS BASED ON LANDHOLDERS’ CERTIFICATION FORMS AND ACCURATELY REPRESENTS THE INFORMATION SUBMITTED BY THE LANDHOLDERS.
I FURTHER ATTEST THAT ALL KNOWN ERRORS, OMISSIONS, AND DISCREPANCIES IN THE LANDHOLDERS’ FORMS ARE LISTED ON FORM 7-21SUMM-C, TABULATION E. THIS FORM MUST
BE SIGNED AND DATED BY AN AUTHORIZED DISTRICT OFFICIAL.

Signature

Title

Date

OMB CONTROL NO.: 1006-0006
BUREAU OF RECLAMATION

DISTRICT SUMMARY OF CERTIFICATION AND
DECLARATION FORMS

FORM 7-21SUMM-C
Tabulation A
2016

District Name:

TABULATION A of Individual and Entity Certification Forms
(Forms 7-2180, 7-2180EZ, and 7-2181)

(7-15)

Do not use this form after December 31, 2016. Type or print in ink. Date and initial crossouts and corrections. Visit www.usbr.gov/rra for more information.

2.

LANDHOLDINGS OF (choose only one):

□

Qualified Recipients
240 through 960
(District Category 1)

□ Qualified Recipients

□

(a)
Name of Direct Landholder

(b)

□ Limited

Qualified
Recipients
Over 960

80 through 960
(District Category 2)

Multidistrict

1.

(c)
Acreage* Directly
Owned
in This District

Recipients
40 through 320
(d)
Acreage* Directly
Leased FROM Other
Parties
in This District

□

□ Limited

Limited
Recipients Over
320 through 640
(e)
Directly Owned
Excess Acreage*
in This District

Recipients
Over 640

(f)
Directly Held
Full-Cost Acreage*
In This District

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
(16)
(17)
(18)
(19)
(20)

3.
4.

TOTAL NUMBER OF ACRES
TOTAL NUMBER OF LANDHOLDERS

(a)
[on this page]

(b)

(a)

(b)

(c)

(d)

(c)

(d)

(e)

(f)

*Irrigable and/or irrigation acres.

OMB CONTROL NO.: 1006-0006
BUREAU OF RECLAMATION

District Name:

DISTRICT SUMMARY OF CERTIFICATION AND
DECLARATION FORMS

FORM 7-21SUMM-C
Tabulation B
2016

TABULATION B of “Declaration of Trust's or Estate's
Landholdings” Forms
(Forms 7-21TRUST)

(7-15)

Do not use this form after December 31, 2016. Type or print in ink. Date and initial crossouts and corrections. Visit www.usbr.gov/rra for more information.

1.

□

Over RRA Forms Submittal Threshold Through 960
(a)
(b)
Name of Trust or Estate
Multidistrict

2.

LANDHOLDINGS OF (choose only one):

□ Over 960

(c)
Acreage* Directly
Owned
in This District

(d)
Acreage* Directly
Leased FROM
Other Parties
in This District

(e)
Directly Owned
Excess Acreage*
in this District

(f)
Directly Held
Full-Cost Acreage*
In This District

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
(16)
(17)
(18)
(19)
(20)

3.

TOTAL NUMBER OF ACRES

4.

(a)
[on this page]

TOTAL NUMBER OF LANDHOLDERS

(b)

(a)

(b)

(c)

(d)

(c)

(d)

(e)

(f)

*Irrigable and/or irrigation acres.

OMB CONTROL NO.: 1006-0006
BUREAU OF RECLAMATION

DISTRICT SUMMARY OF CERTIFICATION AND
DECLARATION FORMS

FORM 7-21SUMM-C
Tabulation C
2016

District Name:

TABULATION C of “Declaration of Public Entity’s
Landholdings” Forms
(Form 7-21PE)

(7-15)

Do not use this form after December 31, 2016. Type or print in ink. Date and initial crossouts and corrections. Visit www.usbr.gov/rra for more information.
(a)
Name of Public Entity

(b)
Multidistrict

1.

(c)
(d)
(e)
(f)
Acreage* Directly
Acreage* Directly
Acreage* Directly
Acreage* Directly
Owned and NOT Owned and Leased
Owned and
Leased and Subject
Leased to or NOT
to or Operated by Subject to Acreage
to Acreage
Operated by Other
Limitation
Other Parties
Limitation
Parties
Application
in This District
Application
in This District
in This District
in This District

(g)
Directly Owned
Excess Acreage*
in This District

(h)
Directly Held
Full-Cost Acreage*
in This District

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
(16)
(17)
(18)
(19)
(20)

2.
3.

TOTAL NUMBER OF ACRES
TOTAL NUMBER OF LANDHOLDERS

(a)

(b)

(a)

(b)

(c)

(d)

(e)

(f)

(c)

(d)

(e)

(f)

(g)

(h)

[on this page]

*Irrigable and/or irrigation acres.

OMB CONTROL NO.: 1006-0006
BUREAU OF RECLAMATION

FORM 7-21SUMM-C
Tabulation D
2016
(7-15)

DISTRICT SUMMARY OF CERTIFICATION AND
DECLARATION FORMS
TABULATION D of “Certification of Religious or Charitable
Organization’s Landholdings” Forms
(Form 7-2184)

District Name:

Do not use this form after December 31, 2016. Type or print in ink. Date and initial crossouts and corrections. Visit www.usbr.gov/rra for more information.
(a)
Name of Religious or Charitable Organization

(b)
Multidistrict

1.

(c)
Acreage* Directly
Owned
in This District

(d)
Acreage* Directly
Leased FROM
Other Parties
in This District

(e)
Directly Owned
Excess Acreage*
in This District

(f)
Directly Held
Full-Cost
Acreage*
in This District

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
(16)
(17)
(18)
(19)
(20)

2.

(a)

3.

(a)

(b)

(c)

(d)

(c)

(d)

(e)

(f)

TOTAL NUMBER OF ACRES
TOTAL NUMBER OF LANDHOLDERS

(b)

[on this page]

*Irrigable and/or irrigation acres.

OMB CONTROL NO.: 1006-0006
BUREAU OF RECLAMATION

FORM 7-21SUMM-C
Tabulation E
2016

DISTRICT SUMMARY OF CERTIFICATION AND
DECLARATION FORMS
TABULATION E of Certification Form Errors,
Omissions, and Discrepancies

District Name:

(7-15)

Do not use this form after December 31, 2016. Type or print in ink. Date and initial crossouts and corrections.
For additional space, use as many copies of this sheet as necessary. Visit www.usbr.gov/rra for more information.
Landholders that hold land over the RRA forms submittal threshold requiring certification that did not receive Reclamation irrigation water and that did not submit a form:
1.
(b) Number of Acres *
(b) Number of Acres*
(a) Name of Landholder
(a) Name of Landholder
in This District

in This District

(1)

(16)

(2)

(17)

(3)

(18)

(4)

(19)

(5)

(20)

(6)

(21)

(7)

(22)

(8)

(23)

(9)

(24)

(10)

(25)

(11)

(26)

(12)

(27)

(13)

(28)

(14)

(29)

(15)

2.

(30)
Landholders that hold land over the RRA forms submittal threshold that received Reclamation irrigation water and that did not submit a form:
(b) Number of Acres*
(a) Name of Landholder
(c) Reason or Explanation for Water Delivery
in This District

(1)
(2)
(3)

3.

Landholders that hold land over the RRA forms submittal threshold requiring certification that submitted a form, but had an error, omission, or discrepancy on the form:
(b) Received
(a) Name of Landholder
(c) Explanation of the Error, Omission, or Discrepancy
Reclamation Irrigation
Water?

YES

NO

(1)
(2)
(3)
*Irrigable and/or irrigation acres.

OMB CONTROL NO.: 1006-0006
BUREAU OF RECLAMATION

District Name:

DISTRICT SUMMARY OF CERTIFICATION AND
DECLARATION FORMS

FORM 7-21SUMM-C
Tabulation F
2016

TABULATION F of Part Owners Subject to
Discretionary Provisions

(7-15)

Do not use this form after December 31, 2016. Type or print in ink. Date and initial crossouts and corrections. List only indirectly held lands. DO NOT transfer information from this sheet to
Form 7-21SUMM-C, “District Summary of Certification and Declaration Forms.” This tabulation sheet is provided for district convenience only and is not required pursuant to the
Reclamation Reform Act of 1982 forms requirements. Visit www.usbr.gov/rra for more information.
(a)
Name of Part Owner

(b)
Name of Entity, Trust or Estate

(c)

Multidistrict

1.

(d)
Does This Part
Owner Directly
Own or Lease
Lands in Their
Name in
This District?
YES

(e)
Acreage*
Indirectly
Owned
Through
Entities in
This District

(f)
Acreage*
Indirectly
Leased
Through
Entities in
This District

(g)
Indirectly
Owned
Excess
Acreage* in
This District

(h)
Indirectly
Held Full-Cost
Acreage* in
This District

(a)

(b)

(c)

(d)

(c)

(d)

(e)

(f)

NO

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
(16)
(17)
(18)
(19)
(20)

2.

TOTAL NUMBER OF ACRES
(b)

(a)

3.

TOTAL NUMBER OF LANDHOLDERS

[on this page]

*Irrigable and/or irrigation acres.

OMB CONTROL NO.: 1006-0006
BUREAU OF RECLAMATION

FORM 7-21SUMM-C
Tabulation G
2016

DISTRICT SUMMARY OF CERTIFICATION AND
DECLARATION FORMS

District Name:

TABULATION G of “Declaration of Farm Operator Information” Forms
(Form 7-21FARMOP)

(7-15)

Do not use this form after December 31, 2016. Type or print in ink. Date and initial crossouts and corrections. Visit www.usbr.gov/rra for more information.

(a)
Name of Farm Operator or Part Owner
(as shown in item 1 of Form 7-21FARMOP)

Farm
Operator

(c)
Multidistrict

(b)
Check Appropriate
Column

1.

Part Owner
of a Farm
Operator

(d)
Number of Acres*
to Which Services
Are Provided in
This District

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
(16)
(17)
(18)
(19)
(20)

2.
3.

(a)

TOTAL NUMBER OF ACRES
TOTAL NUMBER OF FARM OPERATORS AND PART OWNERS

(a)
[on this page]

*Irrigable and/or irrigation acres.

(b)

(c)

(d)