Form FSA-153 Agricultural Foreign Investment Disclosure Act Report

This form is available electronically. AMENDED

Form Approved - OMB No. 0560-0097

13. CERTIFICATION -I certify that the information entered in this report is complete and correct. I understand that falsification of reporting is subject to a civil penalty not to

- Acquired, check			B. Land Acquisition	X
- Disposed of, check - Changed from non-agricultural to agricultural use, check - Changed from agricultural to non-agricultural, use check C. Land Disposition X					D. Land Use Changeto Agriculture E. Land Use Changeto Non-Agriculture	X X	)	If any of these activities are checked in Item 1, return the completed FSA-153 within ninety (90) days from the date of the transaction. REPORTING DATE:
ITEM 8.	The date entered would be as follows for the activity checked in Item 1:
	Box A or B -Date acquired.
	Box C	-Date disposed of.
	Box D or E -Date land use changed.

FSA-153, Page 2 (05-24-01)

NOTE: The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a) and the Paperwork Reduction Act of 1995, as amended. The authority for requesting the following information is Pub. L. 95-460. The information will be used to determine the effects of foreign persons acquiring, transferring and holding agricultural land and the effects of such activity on family farms and rural communities. Furnishing the requested information is mandatory. Failure to comply or falsification of reporting is subject to civil penalty, not to exceed 25 percent of the fair market value of the interest held in the tract on the date of the assessment of such penalty.

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 0560-0097. The time required to complete this information collection is estimated to average30 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.

DETERMINATION OF ''FOREIGN PERSON'' STATUS

DEFINITION: ''Person'' means any individual, corporation, company, association, firm, partnership, society, joint stock company, trust, estate, or any other legal entity.

GENERAL INSTRUCTIONS

Complete this form for each tract of land. Report as a tract all acreages under the same ownership in each county or parish acquired or transferred on the same date. Land in different counties or parishes and land acquired or transferred on different dates must be reported as separate tracts.

Return the original to the County Farm Service Agency (FSA) Office where the tract of land is located. Retain a copy for your records. DO NOT SEND THIS FORM DIRECTLY TO WASHINGTON, D.C. UNLESS GRANTED PERMISSION BY THE FSA IN WASHINGTON, D.C.

After the original disclosure on FSA-153 on the tract(s) of land owned by the same person within a county or parish, each subsequent change of ownership or use must be reported by filing another FSA-153.

ITEM INSTRUCTIONS AND REPORTING DATES

ITEM 1. ONLY ONE BOX MAY BE CHECKED

If the tract of land to be listed under Item 2 on the front side of this document was:

A. Land Holding

-Owned on February 1, 1979, check _X Reporting Date: This document is required to be

)

completed and returned by August 1, 1979. If the tract of land to be listed under Item 2 on the front side of this document was, on or after February 2, 1979:

ADDITIONAL INFORMATION (Use additional sheets if more space is needed) 

1/ Significant interest or substantial control as defined in 7 CFR Part 781.2 (k).

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. (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 USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410 or call (202) 720-5964 (voice or TDD). USDA is an equal opportunity provider and employer.