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pdfOMB CONTROL NO.: 1006-0005
DESIGNATION OF EXCESS LAND
FORM 7-21XS
2024
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, 2024. 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 (2024)
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
Clear Form
OMB CONTROL NO.: 1006-0005
FORM 7-21CONT-O
2024
CONTINUATION SHEET FOR DIRECTLY OWNED LAND
For Certification and Reporting Requirements of the Reclamation Reform Act of 1982
BUREAU OF RECLAMATION
Do not use this form after December 31, 2024. 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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(g)
Number
of
Acres
(h)
PRIOR LAW
ONLY
Was Land
Acquired After
12/06/79?
YES
NO
FORM 7-21CONT-O (2024)
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.)
Self
(a)
District Name
(b)
Legal Description of Land Parcel(s) or
Assessor's Parcel Number(s)
(c)
Operated by:
(check one)
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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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
Clear Form
OMB CONTROL NO.: 1006-0005
FORM 7-21CONT-I
CONTINUATION SHEET FOR INDIRECTLY HELD LAND
For Certification and Reporting Requirements of the Reclamation Reform Act of 1982
2024
BUREAU OF RECLAMATION
Do not use this form after December 31, 2024. 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
(h)
(j)
(f)
(i)
(d)
Double-Counting
(g)
Owned Acreage
PRIOR
(e)
Leased
Percentage
Adjustments
Number of
Number of Attributable to
Acreage
LAW ONLY
of Interest
Acres Leased
the
Acres
Attributable to
Was Owned
the
(2)
Landholder’s by the Entity
Owned by
the
Land Acquired
(1)
Landholder
Adjusted
in Each
the Entity in Interest in the
Landholder’s After 12/06/79?
Owned
Acres
Owns in
Acres
District
Entity
Each District
Interest in the
in (g)
Each Entity
[g minus h(1)]
(d X e)
Entity
YES
NO
1
FORM 7-21CONT-I (2024)
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)
(d)
(g)
Owned Acreage
(e)
Percentage
Number of
Attributable
Number of
of Interest
Acres Leased
to the
Acres
the
Landholder’s by the Entity
Owned by
Landholder
in Each
the Entity in Interest in the
Owns in
District
Entity
Each District
Each Entity
(d X e)
2
(h)
Double-Counting
Adjustments
(1)
Owned
Acres
in (g)
(i)
Leased
Acreage
Attributable to
the
(2)
Landholder’s
Adjusted
Interest in the
Acres
Entity
[g minus h(1)]
(j)
PRIOR LAW
ONLY
Was Owned
Land Acquired
After 12/06/79?
YES
NO
| File Type | application/pdf |
| Author | shartman |
| File Modified | 2023-04-20 |
| File Created | 2017-06-08 |