FSA-2569 Warranty Deed

Close

Form Approved - OMB No. 0560-0233
(See Page 2 for Privacy Act and Public Burden Statements)

This form is available electronically.

FSA-2569
(08-14-08)

U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency

Position 5

WARRANTY DEED
THIS INDENTURE, made on the (a)
between (b)

day of

, by and
, 20
(GRANTOR) of the County of

, in the State of (d)

(c)

,

whose mailing address is (e)
and United States of America, acting through the Farm
Service Agency, whose mailing address is (f)
(GRANTEE):
WITNESSETH, That the GRANTOR, in consideration of the sum of
, and other valuable consideration
to them by the said GRANTEE, the receipt of which is hereby acknowledged does by these presents,
Grant, Bargain and Sell, Convey and Confirm, unto the GRANTEE and its assigns, the following
described Lots, Tracts or Parcels of land, lying, being and situated in the County
of (h)
, and State of (i)
, to wit:
(g)

See attached Exhibit A for legal description
TO HAVE AND TO HOLD the premises aforesaid, with all and singular the rights, privileges,
appurtenances and immunities thereto belonging or in anywise appertaining unto the GRANTEE, and
unto its heirs and assigns, FOREVER, the GRANTOR her eby covena nting that GRANTOR is lawfully
seized of an indefeasible estate in fee in the premises herein conveyed; that GRANTOR has good right to
convey the same; that the said premises are free and clear of any encumbrance done or suffered by
GRANTOR or those under whom GRANTOR claim and that GRANTOR will WARRANT and
DEFEND the title to the said premises unto the GRANTEE, and unto its heirs and assigns, FOREVER,
against the lawful claims and demands of all persons whomsoever.
IN WITNESS WHEREOF, the GRANTOR has hereunto set his hand the day and year first above
written.

(j) Type Name
(k) Type Name

Close

Close

ACKNOWLEDGEMENT

NOTE:

The following statement are made in accordance with the Privacy Act of 1974 (5 USC 552a): the Farm Service Agency (FSA) is
authorized by the Consolidated Farm and Rural Development Act, (7 USC 1921 et seq , and the regulations promulgated thereunder, to
solicit the information requested on this form. The information requested is necessary for FSA to determine eligibility for financial
assistance, service your loan, and conduct statistical analyses. Supplied information maybe furnished to other Department of Agriculture
agencies, the Department of the Treasury, the Department of Justice or other law enforcement agencies, the Department of Defense, the
Department of Housing and Urban Development, the Department of Labor, the United States Postal Service, or other Federal, State, or
local agencies as required or permitted by law. In addition, information may be referred to interested parties under the Freedom of
Information Act (FOIA), to financial consultants, advisors, lending institutions, packagers, agents, and private or commercial credit
sources, to collection or servicing contractors, to credit reporting agencies, to private attorneys under contract with FSA or the
Department of Justice, to business firms in the trade area that buy chattel or crops or sell them for commission, to Members of Congress
or Congressional staff members, or to courts or adjudicative bodies. Disclosure of the information requested is voluntary. However, failure
to disclose certain items of information requested, including your Social Security Number or Federal Tax Identification Number, may
result in a delay in the processing of this form or its rejection.
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
0560-0233. 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 LOCAL FSA OFFICE.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all 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, genetic information, political beliefs, 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, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or
(202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

FSA-2569 (08-14-08) Page 2

Close