7-21XSINAQ Attachment Sheet for Form 7-21XS

OMB CONTROL NO.: 1006-0005

FORM 7-21XSINAQ
2018
(7-17)

ATTACHMENT SHEET FOR FORM 7-21XS
(IDENTIFICATION OF INVOLUNTARILY ACQUIRED EXCESS LAND)
[Required Information for Item 11(d) of Form 7-21XS]
For Certification and Reporting Requirements of the Reclamation
Reform Act of 1982

BUREAU OF RECLAMATION

Do not use this form after December 31, 2018. Separate instructions for the completion of this form are on the reverse side of this page. You may use this attachment sheet to provide required
information if you involuntarily acquired eligible land and designated that land as excess, or you may use your own similar attachment sheet. Type or print in ink. Date and initial crossouts and
corrections. Use as many of these attachment sheets as necessary. Visit www.usbr.gov/rra for more information.

LANDHOLDER NAME:
INVOLUNTARILY ACQUIRED ELIGIBLE LAND DESIGNATED AS EXCESS

(1)
Legal Description of Land Parcel or
Assessor’s Parcel Number

(2)
Name of the Landholder
From Whom Each Parcel Was
Involuntarily Acquired

(3)
Date Each Parcel
Was Involuntarily
Acquired
(m/d/yr)

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(5)
If the Land Was
Excess When It Was
(4)
Involuntarily Acquired,
Status of the Parcel
Why Is the
When It Was
Involuntarily Acquired Land Eligible to Receive
Reclamation Irrigation
Water?

(6)
Acreage Limitation
Status of the
Landholder From
Whom the
Land Was
Involuntarily
Acquired

(7)
Water Rate
Applicable for
Reclamation
Irrigation Water
Delivered to the
Previous Landholder