FSA-2042 Assignment of proceeds & consent to payment

Form Approved – OMB No. 0560-0237

Expiration Date: XX/XX/XXXX

This form is available electronically. (See Page 2 for Privacy Act and Public Burden Statements).

FSA-2042 U.S. DEPARTMENT OF AGRICULTURE Position 1 (XX-XX-25) Farm Service Agency CONSENT TO PAYMENT OF PROCEEDS FROM SALE OF PRODUCTS

PART A - GENERAL

1. Name and Address of Seller      

3. Name and Address of Purchaser      

2. Seller’s Telephone Number      

4. Purchaser’s Telephone Number      

5. Effective Date of Consent      

6. Products Purchased      

PART B – SELLER AGREEMENT

1. The United States, acting through the U.S. Department of Agriculture, Farm Service Agency (FSA), holds a perfected security interest in the above named products, and in the proceeds thereof, which security interest shall remain in full force and effect. However, until the Purchaser is otherwise notified in writing by FSA, such security interest in any such product sold to, by, or through the Purchaser will be satisfied only upon payment, therefore, by the Purchaser to FSA:

(a)

     

percent of the purchase price figured to the nearest dollar, payable (b)

     

(c) $

     

of the purchase price or the full purchase price if less than that amount

payable (d)

     

all proceeds from sales in excess of (e) $

     

payable (f)

     

until FSA releases or suspends this assignment in writing, giving notice of that action to Purchaser.

2. This consent supersedes any previous consent from FSA or assignment to FSA by the Seller regarding such payments.

3A. Signature of Seller

3B. Date      

PART C – PURCHASER ACCEPTANCE

1. The undersigned consents to the above and agrees to remit the sum of money provided above, when due and payable. If payment is made by check, the check will be payable and delivered as provided below:

(a) To the order of the Farm Service Agency

(b) Jointly to the order of the Seller and the Farm Service Agency

(c) To the order of

     

     

2. Name of Purchaser’s Duly Authorized Officer for Purchaser      

3. Title      

4. Signature

5. Date      

FSA-2042 (XX-XX-25)) Page 2 of 2

PART D – FSA USE
1. Name of Agency Official      	2. Title      
3. Signature	4. Date      
5. Address of FSA Office      	6. Telephone Number      

NOTE:

The following statements 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, as amended (7 USC 1921 et seq.), or other Acts, and the regulations promulgated thereunder, to solicit the information requested on its application forms. The information requested is necessary for FSA to determine eligibility for credit or other financial assistance, service your loan, and conduct statistical analyses. Supplied information may be furnished to other Department of Agriculture agencies, the Internal Revenue Service, 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 an application 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 0560-0237. The time required to complete this information collection is estimated to average 20 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.

Non-Discrimination Statement: 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, 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 State or local Agency that administers the program or contact USDA through the Telecommunications Relay Service at 711 (voice and TTY). 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 https://www.usda.gov/oascr/how-to-file-a-program-discrimination-complaint 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, Mail Stop 9410, Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: [email protected].

USDA is an equal opportunity provider, employer, and lender.