Form 7-21XS Designation of Excess Land

OMB CONTROL NO.: 1006-0005

DESIGNATION OF EXCESS LAND

FORM 7-21XS
2021

For Certification and Reporting Requirements of the
Reclamation Reform Act of 1982

Districts must complete the “District Name” and “Date Received” boxes.
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,
city, state, and ZIP code:

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

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

4(b). Contact person:

5.

Landholder’s ownership entitlement:

□

160 Acres

)

□ 320 Acres

□ 640 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 designate land as excess, identify the part owner(s):

6(b).

Trusts/Estates only: Identify the attributed direct/indirect landowner(s) who exceeds their ownership entitlement, causing the trust/estate to complete this form:

7.

List all directly owned land to be designated nonexcess. Refer to the separate instructions for further guidance regarding the use of columns (d) and (e). For additional space, use attachments.
(a)
District Name

8.

(c)
Actual Acres

(d) Class 1
Equivalency
Factor

(e) Class 1
Equivalent Acres

List all indirectly owned land to be designated nonexcess. This information must be obtained from the direct landowner’s “Designation of Excess Land” (Form 7-21XS) if such a form has been completed by
the direct landowner. Refer to the separate instructions for further guidance regarding column (c). For additional space, use attachments.

(a)
District Name

9.

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

(d)
(c)
Type of Acres Included
(e)
Acres Designated
in Item 8(c):
Percentage
as Nonexcess
(check one)
Attributed
by the Direct
to This Landholder
Class
1
Landowner
Actual
Equivalent

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

TOTAL NONEXCESS ACREAGE (use the workspace provided in the instructions for item 9 to calculate this total):
1

(f)
Number of
Nonexcess Acres
Attributed to
This Landholder
(c X e)

FORM 7-21XS (2021)
10. LANDHOLDER NAME:
11. List excess land this landholder directly owns westwide. Refer to the separate instructions that accompany this form for special direction regarding item 11(d). For additional space, use attachments.
(a)
District Name

(c)
Type of Irrigation
Water Received

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

Project

Nonproject

None

(d)
If “Project” is checked in item (c), explain why
land is eligible (e.g., involuntary acquisition,
recordable contract, etc.)
NOTE: If land is receiving water under the involuntary
acquisition provisions, see the
separate instructions on this form.

(e)
Number of
Actual
Excess Acres

12.
TOTAL NUMBER OF ACTUAL EXCESS ACRES THIS LANDHOLDER DIRECTLY OWNS WESTWIDE
13. List excess land indirectly owned westwide that is attributed to this landholder by this landholder’s interest in an entity, trust, or estate. This information must be obtained from the direct landowner’s
“Designation of Excess Land” (Form 7-21XS). Refer to the separate instructions for further guidance regarding column (c). For additional space, use attachments.
(c)
Actual Acres
Designated as
Excess by the
Direct Landowner

(b)
Direct Landowner
Enity, Trust or Estate Name)

(a)
District Name

14.
15.
16.

(d)
Percentage
Attributed to
This
Landowner

(e)
Number of
Excess Acres Attributed to
This Landowner
(c X d)

TOTAL NUMBER EXCESS ACRES THIS LANDHOLDER INDIRECTLY OWNS WESTWIDE
TOTAL EXCESS ACREAGE (this is the sum of item 12 and item 14)
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. It is the direct landowner’s responsibility to notify potential buyers of excess land of the actions needed to make the land eligible to receive Reclamation irrigation water.

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

Date

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

Spouse’s Signature or Other Required Signature

Date

Other Required Signature

Date

Other Required Signature

Date

Other Required Signature

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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(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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Name:

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Address:

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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

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