FSA-2006 Property Owned and Leased

This form is available electronically.

FSA-2006
07-29-19)

1. Name of Applicant

Form Approved - OMB No. 0560-0237
Expiration Date: 12/31/2025
(See Page 2 for the Privacy Act and the Public Burden Statements.)
U.S. DEPARTMENT OF AGRICULTURE
Position 3
Farm Service Agency

PROPERTY OWNED AND LEASED

A. LAND. Include all land owned, to be owned, or leased.
1A. Owner of Record

1D. Farm No.

1E. Total
Acres

2A. Owner of Record

2D. Farm No.

2E. Total
Acres

3A. Owner of Record

3D. Farm No.

3E. Total
Acres

4A. Owner of Record

4D. Farm No.

4E. Total
Acres

5A. Owner of Record

5D. Farm No.

5E. Total
Acres

1B. Description

1F. Crop Acres

1G. Oral/
Written
Lease

1C. County

1H. Crop
Share
%

2B. Description

2F. Crop Acres

2G. Oral/
Written
Lease

1I. Cash Rent

2H. Crop
Share

$

2I. Cash Rent
%

3G. Oral/
Written
Lease

4G. Oral/
Written
Lease

3H. Crop
Share

3I. Cash Rent
%

4H. Crop
Share

5G. Oral/
Written
Lease

$

4I. Cash Rent

%

5B. Description

5F. Crop Acres

2J. Expiration Date

3C. County

4B. Description

4F. Crop Acres

2C. County

$

3B. Description

3F. Crop Acres

1J. Expiration Date

5H. Crop
Share

$

5I. Cash Rent

%

3J. Expiration Date

4C. County

4J. Expiration Date

5C. County

5J. Expiration Date

$

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or
administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital
status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not
all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.
Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or
USDA's TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages
other than English.
To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office
or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to
USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email:
[email protected]. USDA is an equal opportunity provider, employer, and lender.

FSA-2006 (07-29-19)

B. EQUIPMENT/LIVESTOCK. Include only equipment/livestock to be purchased, currently leased, or to be
1.
2.leased.
3.
4.
5.
6.
Owner of Record
Description
Number of
Rent
Share
Type of Lease
Units
$
%

Page 2 of 2

7.
Expiration Date

C. CERTIFICATION

I certify that the information provided is true, complete, and correct to the best of my knowledge and is provided in good faith.
(Warning: Section 1001 of title 18, United States Code, provides for criminal penalties to those who provide false statements. If
any information is found to be false or incomplete, such finding may be grounds for denial of the requested action.)
1. Signature
NOTE:

2. Date

The following is made in accordance with the Privacy Act of 1974 (5 USC 552a - as amended). The authority for requesting the
information identified on this form is the Consolidated Farm and Rural Development Act, as amended (7 U.S.C. 1921 et. seq.).
The information will be used to determine eligibility and feasibility for loans and loan guarantees, and servicing of loans and loan
guarantees. The information collected on this form may be disclosed to other Federal, State, and local government agencies,
Tribal agencies, and nongovernmental entities that have been authorized access to the information by statute or regulation and/
or as described in the applicable Routine Uses identified in the System of Records Notice for USDA/FSA-14, Applicant/
Borrower. Providing the requested information is voluntary. However, failure to furnish the requested information may result in
a denial for loans and loan guarantees, and servicing of loans and loan guarantees. The provisions of criminal and civil fraud,
privacy, and other statutes may be applicable to the information provided.
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 0560-0237. The time required to complete this information collection is estimated to average 30
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.