FSA-2476 Transfer of real estate security/transferee

This form is available electronically. Form Approved – OMB No. 0560-0236

(See Page 2 for Privacy Act and Paperwork Reduction Act Statements).

FSA-2476 U.S. DEPARTMENT OF AGRICULTURE Position 5 (03-29-12) Farm Service Agency TRANSFER OF REAL ESTATE SECURITY
PART A - GENERAL
1. Transferor’s Name      						2. Transferee’s Name      
3A. Real estate to be transferred      						3B. Current value $     
4A. Other property, besides real estate, to be transferred      							4B. Current value $     
5. Reasons for transfer      
6. Amount in Supervised Bank Account $     				7. Planned disposition of funds in Supervised Bank Account      
8. Development to be completed, estimated cost, and source of funds      
9A. Prior lien $     					9B. Is consent of prior lienholder required?					YES	NO
										 	 
10A. Junior lien $     					10B. Is consent of junior lienholder required?					 	 
11. Taxes and assessments due and payable $     			12. Date transfer to be complete      					13. Transferee operating/occupying property. If “NO” expected Date:      		 	 
14. If property is operated, occupied, or leased by other than transferee, provide terms and conditions of occupancy or lease:      
15. Direct debts owed FSA to be transferred:
A. Loan Number	B. Amount	C. Security							D. Comment
     	$      	     							     
     	$      	     							     
     	$      	     							     
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-2476 (03-29-12) Page 2 of 2

PART B – AGREEMENTS BETWEEN TRANSFEROR AND TRANSFEREE
Transferor and transferee certify that the agreements reached for the transfer of security are made between transferor and transferee and the information provided herein is correct and fully understood by each.
1. Total consideration for transfer of security is					$      
2. Payment or assumption of prior liens:			     
3. Payment or assumption of junior liens:				     
4. Payment of taxes (Including current year's taxes):						     
5. Assignment of property insurance and paid unearned premiums:							     
6. Distribution of income from rentals, easements, mineral leases, etc.:								     
7. Disposition of existing abstracts of Title, Owner's Title Insurance Policy or other title evidence:      
8. Expenses to be paid by Transferor:		     
9. Expenses to be paid by Transferee:		     
10. Transferee will:											AMOUNT
(a) assume an indebtedness to FSA of											$      
(b) assume indebtedness to		     									$      
(c) assume indebtedness to		     									$      
(d) pay transferor (as equity) (Part B, Item 1 minus, Items 10(a), 10(b), and 10(c))											$      
PART C – SIGNATURES
1A. Transferor Signature										1B. Date      
2A. Transferee Signature										2B. Date      
3A. Authorized Agency Official Name      									3B. Title      
3C. Signature										3D. Date      
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 0560-0236. 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.