Form 7-21FC Selection of Full-Cost Land

OMB CONTROL NO.: 1006-0005

Districts must complete the “District Name” and “Date Received” boxes.

FORM 7-21FC
2021

SELECTION OF FULL-COST LAND
For Certification and Reporting Requirements of the
Reclamation Reform Act of 1982

District Name

DATE RECEIVED:

BUREAU OF RECLAMATION

Do not use this form after December 31, 2021. It is important that you read the separate instructions that accompany this form before completing it. If you did not
receive these instructions, please contact your district office. Type or print in ink. Date and initial crossouts and corrections. Visit www.usbr.gov/rra for more information.

1.
2.

Landholder name:
Spouse name, if married:

3(a). Landholder’s, trustee’s, executor’s, or administrator’s street address or rural route number,

3(b). Mailing address if different from street address:

city, state, and ZIP code:

4(a). Telephone number where questions can be directed: (

5.

Landholder’s nonfull-cost entitlement:

□

0 Acres

)

□

160 Acres

□

4(b). Contact person:
320 Acres

□

960 Acres

□

□

Other: ____________Acres

Trust or Estate

6(a). Entities only: If the reason for completing this form is due solely to a part owner’s need to select land as full-cost, identify the part owner(s):
6(b). Trusts/Estates only: Identify the attributed direct/indirect landholder(s) who exceeds their nonfull-cost entitlement, causing the trust/estate to complete this form:

7.

List all directly owned and leased land selected to receive Reclamation irrigation water at nonfull-cost rates. Refer to the separate instructions for further guidance regarding the use of
columns (d) and (e). For additional space, use attachments.
(a)
(b)
(c)
(d) Class 1
(e) Class 1
District Name
Legal Description of Land Parcel(s) or Assessor’s Parcel Number(s)
Actual Acres
Equivalency Factor
Equivalent Acres

8.

List all indirectly owned and leased land selected to receive Reclamation irrigation water at nonfull-cost rates. This information must be obtained from the direct landholder’s
“Selection of Full-Cost Land” (Form 7-21FC) if such a form has been completed by the direct landholder. Refer to the separate instructions for further guidance regarding column (c).
For additional space, use attachments.

(a)
District Name

9.
10.

(c)
Acres Selected as
Nonfull-Cost
by the
Direct Landholder

(b)
Direct Landholder
(Entity, Trust, or Estate Name)

(d)
Type of Acres
Included in Item 8(c):
(check one)
Actual

(e) Percentage
Attributed to This
Landholder

Class 1
Equivalent

TOTAL NONFULL-COST ACREAGE TO RECEIVE WATER AT NONFULL-COST RATES (use the workspace provided in the instructions for item 9 to calculate this total):

If the total nonfull-cost acreage in item 9 is greater than this landholder’s nonfull-cost entitlement, please explain why:

1

(f)
Number of
Nonfull-Cost
Acres Attributed to
This Landholder
(c X e)

FORM 7-21FC (2021)
11. LANDHOLDER NAME:
12. List directly or indirectly owned and leased land that is not receiving Reclamation irrigation water.
(a)
District Name

13.
14.

(d)
(b)
(c)
Actual Acres Selected by the
Legal Description of Land Parcel(s)
Name of the Direct Landholder for
Direct Landholder as Not
or Assessor’s Parcel Number (s) for
Indirectly Held Land
Receiving Reclamation
Directly Held Land
Irrigation Water

(f)
Not
Irrigated

(g)
Receiving
Nonproject
Water

(h)
Number of
Actual Acres
(d X e)

TOTAL NUMBER OF ACTUAL ACRES THAT ARE NOT RECEIVING RECLAMATION IRRIGATION WATER
(c)
Number of
Actual
Full-Cost Acres

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

TOTAL NUMBER OF ACTUAL ACRES THIS LANDHOLDER DIRECTLY OWNS AND LEASES FOR WHICH THE FULL-COST RATE WILL BE PAID
List indirectly owned and leased land for which the full-cost rate will be paid. This information must be obtained from the direct landholder’s “Selection of Full-Cost Land” (Form 7-21FC).
Refer to the separate instructions for further guidance regarding column (c). For additional space, use attachments.
(c)
Actual Acres
Selected as
Full-Cost by the
Direct Landholder

(b)
Direct Landholder
(Entity, Trust, or Estate Name)

(a)
District Name

17.
18.
19.

(e)
Percent of Actual Acres
Attributable to This
Landholder

List directly owned and leased land for which the full-cost rate will be paid. For additional space, use attachments.
(a)
District Name

15.
16.

For additional space, use attachments.

(d)
Percentage
Attributed to
This
Landholder

(e)
Number of
Full-Cost Acres
Attributed to
This Landholder
(c X d)

TOTAL NUMBER OF ACRES THIS LANDHOLDER INDIRECTLY OWNS AND LEASES FOR WHICH THE FULL-COST RATE WILL BE PAID

TOTAL FULL-COST ACREAGE (this is the sum of item 15 and item 17)
SIGNATURE(S)

This form must be signed and dated as well as the standard form it accompanies. The spouse of a married, individual landholder must sign this form. This requirement applies even if the land is not
jointly held. You may use a written spousal signature authorization to permit one spouse to sign for the couple. All partners, joint tenants, or co-tenants must sign this form. However, a written signature
authorization may be used to permit one natural person to sign for the entity. All trustees, executors, or administrators must sign this form unless the trust or a power of attorney authorizes one individual
to sign for the trust or estate.

Signature of Landholder, Authorized Agent,
Trustee, Executor, or Administrator

Date

Spouse’s Signature or Other Required Signature

Date

Other Required Signature

Date

Date

Other Required Signature

Date

Other Required Signature

Agent's Title (if applicable) or Other Required Signature and Date

PLEASE RETURN THIS FORM TO THE APPROPRIATE DISTRICT OFFICE(S).
2

OMB CONTROL NO.: 1006-0005

CONTINUATION SHEET FOR DIRECTLY OWNED LAND
For Certification and Reporting Requirements of the
Reclamation Reform Act of 1982

FORM 7-21CONT-O
2021
BUREAU OF RECLAMATION

Do not use this form after December 31, 2021. Refer to the instructions of the form for which you are preparing this continuation sheet. You may use this continuation sheet for additional space when
listing directly owned land, or you may use your own similar continuation sheet. Type or print in ink. Date and initial crossouts and corrections. Only landholders subject to prior law provisions should
complete column (h). Use as many of these continuation sheets as necessary. Visit www.usbr.gov/rra for more information.

LANDHOLDER NAME(S):
THIS FORM IS A CONTINUATION OF FORM 7-21__________________ DATED _______________________
LAND THE LANDHOLDER DIRECTLY OWNS

Other

Lessee/
Sublessee

(There is space to list four different parcels
[one parcel per line] if they all are operated by the
same natural person or entity in the same district.)

(c)
Operated by:
(check one)
Self

(a)
District Name

(b)
Legal Description of Land Parcel(s) or
Assessor's Parcel Number(s)

Lease Information
(d)
Identification of the Lessee, Sublessee, or Other Operator

(e)
Starting Date
(m/d/yr)

(f)
Ending Date
(m/d/yr)

Name:

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Address:

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Telephone:

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(g)
Number
of
Acres

(h)
PRIOR LAW
ONLY
Was Land
Acquired After
12/06/79?

YES

NO

FORM 7-21CONT-O (2021)
LANDHOLDER NAME(S):
THIS FORM IS A CONTINUATION OF FORM 7-21__________________ DATED _______________________
LAND THE LANDHOLDER DIRECTLY OWNS

Other

Lessee/
Sublessee

(There is space to list four different parcels
[one parcel per line] if they all are operated by the
same natural person or entity in the same district.)

(c)
Operated by:
(check one)
Self

(a)
District Name

(b)
Legal Description of Land Parcel(s) or
Assessor's Parcel Number(s)

Lease Information
(d)
Identification of the Lessee, Sublessee, or Other Operator

(e)
Starting Date
(m/d/yr)

(f)
Ending Date
(m/d/yr)

Name:

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Address:

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Telephone:

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Telephone:

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(g)
Number
of
Acres

(h)
PRIOR LAW
ONLY
Was Land
Acquired After
12/06/79?

YES

NO

OMB CONTROL NO.: 1006-0005

FORM 7-21CONT-L
2021

CONTINUATION SHEET FOR DIRECTLY LEASED LAND
For Certification and Reporting Requirements of the Reclamation Reform Act of 1982

BUREAU OF RECLAMATION

Do not use this form after December 31, 2021. Refer to the instructions of the form for which you are preparing this continuation sheet. You may use this continuation sheet for additional space when
listing directly leased land, or you may use your own similar continuation sheet. Type or print in ink. Date and initial crossouts and corrections. Use as many of these continuation sheets as necessary.
Visit www.usbr.gov/rra for more information.

LANDHOLDER NAME(S):
THIS FORM IS A CONTINUATION OF FORM 7-21__________________ DATED _______________________
LAND THE LANDHOLDER DIRECTLY LEASES FROM ANOTHER PARTY

Other

(c) Operated by:
(check one)
Self

(a)
District Name

(b)
Legal Description of Land Parcel(s) or
Assessor's Parcel Number(s)

(d)
Landowner’s Name
[If the land has been subleased or is
operated by a farm operator, see the
instructions to the form for other needed names.]

1

Lease Information
(e)
Starting Date
(m/d/yr)

(f)
Ending Date
(m/d/yr)

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(g)
Number of
Acres

FORM 7-21CONT-L (2021)
LANDHOLDER’S NAME:
THIS FORM IS A CONTINUATION OF FORM 7-21__________________ DATED _______________________
LAND THE LANDHOLDER DIRECTLY LEASES FROM ANOTHER PARTY

Other

Self

(a)
District Name

(b)
Legal Description of Land Parcel(s) or
Assessor's Parcel Number(s)

(c) Operated by:
(check one)

(d)
Landowner’s Name
[If the land has been subleased or is
operated by a farm operator, see the
instructions to the form for other needed names.]

2

Lease Information
(e)
Starting Date
(m/d/yr)

(f)
Ending Date
(m/d/yr)

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(g)
Number of
Acres

OMB CONTROL NO.: 1006-0005

CONTINUATION SHEET FOR INDIRECTLY HELD LAND
For Certification and Reporting Requirements of the Reclamation Reform Act of 1982

FORM 7-21CONT-I
2021
BUREAU OF RECLAMATION

Do not use this form after December 31, 2021. Refer to the instructions of the form for which you are preparing this continuation sheet. You may use this continuation sheet for additional space when listing indirectly held
land, or you may use your own similar continuation sheet. Type or print in ink. Date and initial crossouts and corrections. Only landholders subject to prior law provisions should complete column (j). Use as many of these
continuation sheets as necessary. Visit www.usbr.gov/rra for more information.

LANDHOLDER NAME(S):
THIS FORM IS A CONTINUATION OF FORM 7-21__________________ DATED _______________________
LAND THE LANDHOLDER INDIRECTLY HOLDS THROUGH OTHER ENTITIES

(a)
District Name

(b)
Name of Entity

(c)
Entity Employer
Identification Number

(f)
(h)
(i)
(d)
Owned
Double-Counting
Leased
(e)
(g)
Percentage
Acreage
Acreage
Adjustments
Number of
Number of
of Interest
Attributable
Attributable to
Acres
Acres Leased
the
to the
(2)
the
Owned by
by the Entity
(1)
Landholder
Landholder’s
Adjusted
Landholder’s
the Entity in
in Each
Owned
Acres
Owns in
Interest in the
Acres
Interest in the
Each District
District
in (g)
Each Entity
Entity
[g minus h(1)]
Entity
(d X e)

1

(j)
PRIOR LAW
ONLY
Was Owned
Land Acquired
After 12/06/79?

YES

NO

FORM 7-21CONT-I (2021)
LANDHOLDER’S NAME:
THIS FORM IS A CONTINUATION OF FORM 7-21__________________ DATED _______________________
LAND THE LANDHOLDER INDIRECTLY HOLDS THROUGH OTHER ENTITIES

(a)
District Name

(b)
Name of Entity

(c)
Entity Employer
Identification Number

(f)
Owned
(d)
(e)
Acreage
Percentage
Number of
Attributable
of Interest
Acres
to the
the
Owned by
Landholder’s
Landholder
the Entity in
Interest in the
Owns in
Each District
Entity
Each Entity
(d X e)

2

(g)
Number of
Acres
Leased
by the Entity
in Each
District

(h)
Double-Counting
Adjustments
(1)
Owned
Acres
in (g)

(j)
(i)
PRIOR LAW
Leased
ONLY
Acreage
Was Owned
Attributable to
Land Acquired
the
(2)
Landholder’s After 12/06/79?
Adjusted
Interest in the
Acres
Entity
[g minus h(1)]
YES
NO