Document
Emergency Conservation Program and Biomass Crop Assistance Program (BCAP) - Individuals
ICR 202606-0560-002 · OMB 0560-0082 · Object 169993400.
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Document Metadata
| File Type | message/rfc822 |
|---|---|
| File Title | Emergency Conservation Program and Biomass Crop Assistance Program (BCAP) - Individuals |
| Last Modified By | Writer |
| File Created | 2026-10-09 |
| Conversion State | complete |
Extracted Text
From: <Saved by Windows Internet Explorer 7>
Subject: Instructions For CCC-901
Date: Mon, 20 Dec 2010 16:49:52 -0500
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<DIV class=3DSection1>
<H1>Instructions For CCC-901</H1>
<H2>MEMBER'S INFORMATION</H2>
<H3>Producers are required to complete this form to report information =
about=20
their farming operation. This information is used by FSA to determine =
the=20
ownership interest of entities for payment limitation purposes.</H3>
<P class=3DMsoNormal><B=20
style=3D"mso-bidi-font-weight: normal"><o:p> </o:p></B></P>
<P class=3DMsoNormal><B style=3D"mso-bidi-font-weight: normal">Submit =
the original=20
of the completed form in hard copy or facsimile to the appropriate FSA =
servicing=20
office.</B> </P>
<P class=3DMsoNormal><B style=3D"mso-bidi-font-weight: normal"><SPAN=20
style=3D"LAYOUT-GRID-MODE: line"><o:p> </o:p></SPAN></B></P>
<P class=3DMsoNormal><B style=3D"mso-bidi-font-weight: normal"><SPAN=20
style=3D"LAYOUT-GRID-MODE: line">Customers who have established =
electronic access=20
credentials with USDA may electronically transmit this form to the USDA=20
servicing office, <U>provided</U> that (1) the customer submitting the =
form is=20
the only person required to sign the transaction, or (2) the customer =
has an=20
approved Power of Attorney (Form FSA-211) on file with USDA to sign for =
other=20
customers for the program and type of transaction represented by this=20
form.</SPAN></B><B style=3D"mso-bidi-font-weight: normal"><SPAN=20
style=3D"FONT-SIZE: 10pt; mso-bidi-font-size: =
12.0pt"><o:p></o:p></SPAN></B></P>
<P class=3DMsoNormal><B style=3D"mso-bidi-font-weight: normal"><SPAN=20
style=3D"FONT-SIZE: 10pt; mso-bidi-font-size: =
12.0pt"><o:p> </o:p></SPAN></B></P>
<P class=3DMsoNormal><B style=3D"mso-bidi-font-weight: normal"><SPAN=20
style=3D"LAYOUT-GRID-MODE: line">Features for transmitting the form =
electronically=20
are available to those customers with access credentials only.<SPAN=20
style=3D"mso-spacerun: yes"> </SPAN>To establish online access =
credentials=20
with USDA, follow the instructions provided at the USDA eForms web=20
site.</SPAN><o:p></o:p></B></P>
<H2>All items applicable to the payment entity must be completed by =
following=20
the instructions provided below.</H2>
<H4>Items 1-3</H4>
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<P class=3DHeading3Cent>Fld Name /<BR>Item No.</P></TD>
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<P class=3DHeading3Cent>Instruction</P></TD></TR></THEAD>
<TBODY>
<TR style=3D"HEIGHT: 30.1pt; mso-yfti-irow: 1">
<TD=20
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<P class=3DMsoNormal>1 and 2</P>
<P class=3DMsoNormal>County and State Name</P></TD>
<TD=20
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<P class=3DMsoNormal>Enter the name of the county and State where =
the=20
farming operation is located.<SPAN style=3D"mso-spacerun: =
yes"> =20
</SPAN>If in more than one county, enter the name of the county =
that has=20
been designated as the administrative county.<SPAN=20
style=3D"mso-spacerun: yes"> </SPAN></P></TD></TR>
<TR style=3D"HEIGHT: 30.1pt; mso-yfti-irow: 2; mso-yfti-lastrow: yes">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
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BORDER-BOTTOM: windowtext 1.5pt solid; HEIGHT: 30.1pt; =
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vAlign=3Dtop width=3D108>
<P class=3DMsoNormal>3</P>
<P class=3DMsoNormal>Program Year</P></TD>
<TD=20
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<P class=3DMsoNormal>Enter the current program year, or the year =
for which=20
this information is applicable. =
</P></TD></TR></TBODY></TABLE></DIV>
<H4>Part A, Items 1-5</H4>
<DIV align=3Dcenter>
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<THEAD>
<TR style=3D"HEIGHT: 30.1pt; mso-yfti-irow: 0; mso-yfti-firstrow: =
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<TD=20
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vAlign=3Dtop width=3D108>
<P class=3DHeading3Cent>Fld Name /<BR>Item No.</P></TD>
<TD=20
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<P class=3DHeading3Cent>Instruction</P></TD></TR></THEAD>
<TBODY>
<TR style=3D"HEIGHT: 30.1pt; mso-yfti-irow: 1">
<TD=20
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<P class=3DMsoNormal>Part A</P>
<P class=3DMsoNormal>Legal Entity Name</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
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<P class=3DMsoNormal>Enter the name of the legal entity earning =
the=20
payment.</P>
<P class=3DMsoNormal><o:p> </o:p></P>
<P class=3DMsoNormal><o:p> </o:p></P></TD></TR>
<TR style=3D"HEIGHT: 8.4pt; mso-yfti-irow: 2">
<TD=20
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<P class=3DMsoNormal>1</P>
<P class=3DMsoNormal>Member=92s Name</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
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<P class=3DMsoNormal>Enter the names of the members making up the =
legal=20
entity listed in Part A. <I style=3D"mso-bidi-font-style: =
normal">(This=20
could be a person or a legal entity.)<o:p></o:p></I></P></TD></TR>
<TR style=3D"HEIGHT: 30.1pt; mso-yfti-irow: 3">
<TD=20
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vAlign=3Dtop width=3D108>
<P class=3DMsoNormal>2</P>
<P class=3DMsoNormal>Social Security Number/ Tax ID =
Number</P></TD>
<TD=20
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BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: medium none; WIDTH: 351pt; PADDING-TOP: 0in; BORDER-BOTTOM: =
windowtext 1.5pt solid; HEIGHT: 30.1pt; mso-border-left-alt: solid =
windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D468>
<P class=3DMsoNormal>Enter the social security number or tax =
identification=20
number of the members. <I=20
style=3D"mso-bidi-font-style: =
normal"><o:p></o:p></I></P></TD></TR>
<TR style=3D"HEIGHT: 30.1pt; mso-yfti-irow: 4">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: windowtext 1.5pt solid; WIDTH: 81pt; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; HEIGHT: 30.1pt; =
mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D108>
<P class=3DMsoNormal>3</P>
<P class=3DMsoNormal>Address</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: medium none; WIDTH: 351pt; PADDING-TOP: 0in; BORDER-BOTTOM: =
windowtext 1.5pt solid; HEIGHT: 30.1pt; mso-border-left-alt: solid =
windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D468>
<P class=3DMsoNormal>Enter the address of each member of the legal =
entity.</P></TD></TR>
<TR style=3D"HEIGHT: 30.1pt; mso-yfti-irow: 5">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: windowtext 1.5pt solid; WIDTH: 81pt; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; HEIGHT: 30.1pt; =
mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D108>
<P class=3DMsoNormal>4</P>
<P class=3DMsoNormal>Percent Share</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: medium none; WIDTH: 351pt; PADDING-TOP: 0in; BORDER-BOTTOM: =
windowtext 1.5pt solid; HEIGHT: 30.1pt; mso-border-left-alt: solid =
windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D468>
<P class=3DMsoNormal>Enter the percent share of the legal entity =
that each=20
member owns.</P></TD></TR>
<TR style=3D"HEIGHT: 30.1pt; mso-yfti-irow: 6; mso-yfti-lastrow: yes">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: windowtext 1.5pt solid; WIDTH: 81pt; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; HEIGHT: 30.1pt; =
mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D108>
<P class=3DMsoNormal>5</P>
<P class=3DMsoNormal>Signature Authority</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: medium none; WIDTH: 351pt; PADDING-TOP: 0in; BORDER-BOTTOM: =
windowtext 1.5pt solid; HEIGHT: 30.1pt; mso-border-left-alt: solid =
windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D468>
<P class=3DMsoNormal>Check =93YES=94 if the member has signature =
authority for=20
this entity.</P>
<P class=3DMsoNormal>Check =93NO=94 if the member does not have =
signature=20
authority for<SPAN=20
style=3D"mso-spacerun: yes"> =
</SPAN>this=20
entity.</P></TD></TR></TBODY></TABLE></DIV>
<H4>Part B</H4>
<H3>Embedded Legal Entities =96 If any member listed in Part A, Item 3 =
is a legal=20
entity (i.e., part of another partnership, corporation, etc.) list the =
members=20
of that legal entity in this item. <SPAN=20
style=3D"mso-spacerun: yes"> </SPAN>(If more than one member is a =
legal=20
entity, use a separate, supplemental sheet to provide the requested =
information=20
for each embedded legal entity.)</H3>
<H4>Part B, Items 1-5</H4>
<DIV align=3Dcenter>
<TABLE class=3DMsoNormalTable=20
style=3D"BORDER-RIGHT: medium none; BORDER-TOP: medium none; =
BORDER-LEFT: medium none; BORDER-BOTTOM: medium none; BORDER-COLLAPSE: =
collapse; mso-border-alt: solid windowtext 1.5pt; mso-padding-alt: 0in =
5.4pt 0in 5.4pt; mso-border-insideh: 1.5pt solid windowtext; =
mso-border-insidev: 1.5pt solid windowtext"=20
cellSpacing=3D0 cellPadding=3D0 border=3D1>
<THEAD>
<TR style=3D"HEIGHT: 30.1pt; mso-yfti-irow: 0; mso-yfti-firstrow: =
yes">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: windowtext 1.5pt solid; PADDING-LEFT: 5.4pt; BACKGROUND: =
aqua; PADDING-BOTTOM: 0in; BORDER-LEFT: windowtext 1.5pt solid; WIDTH: =
76.8pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1.5pt solid; HEIGHT: =
30.1pt"=20
vAlign=3Dtop width=3D102>
<P class=3DHeading3Cent>Fld Name /<BR>Item No.</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: windowtext 1.5pt solid; PADDING-LEFT: 5.4pt; BACKGROUND: =
aqua; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 5in; =
PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1.5pt solid; HEIGHT: 30.1pt; =
mso-border-left-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D480>
<P class=3DHeading3Cent>Instruction</P></TD></TR></THEAD>
<TBODY>
<TR style=3D"HEIGHT: 30.1pt; mso-yfti-irow: 1">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: windowtext 1.5pt solid; WIDTH: 76.8pt; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; HEIGHT: 30.1pt; =
mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D102>
<P class=3DMsoNormal>Part B</P>
<P class=3DMsoNormal>Embedded Legal Entity Name</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: medium none; WIDTH: 5in; PADDING-TOP: 0in; BORDER-BOTTOM: =
windowtext 1.5pt solid; HEIGHT: 30.1pt; mso-border-left-alt: solid =
windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D480>
<P class=3DMsoNormal>Enter the name of the embedded legal entity =
that is a=20
member of the legal entity entered in Part A.</P>
<P class=3DMsoNormal><o:p> </o:p></P></TD></TR>
<TR style=3D"HEIGHT: 30.1pt; mso-yfti-irow: 2">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: windowtext 1.5pt solid; WIDTH: 76.8pt; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; HEIGHT: 30.1pt; =
mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D102>
<P class=3DMsoNormal>1</P>
<P class=3DMsoNormal>Member=92s Name</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: medium none; WIDTH: 5in; PADDING-TOP: 0in; BORDER-BOTTOM: =
windowtext 1.5pt solid; HEIGHT: 30.1pt; mso-border-left-alt: solid =
windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D480>
<P class=3DMsoNormal>Enter the names of the members making up the =
legal=20
entity listed in<SPAN style=3D"mso-spacerun: yes"> =
</SPAN>Part B. <I=20
style=3D"mso-bidi-font-style: normal">(This could be a person or a =
legal=20
entity.)<o:p></o:p></I></P></TD></TR>
<TR style=3D"HEIGHT: 30.1pt; mso-yfti-irow: 3">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: windowtext 1.5pt solid; WIDTH: 76.8pt; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; HEIGHT: 30.1pt; =
mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D102>
<P class=3DMsoNormal>2 </P>
<P class=3DMsoNormal>Social Security/Tax ID Number</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: medium none; WIDTH: 5in; PADDING-TOP: 0in; BORDER-BOTTOM: =
windowtext 1.5pt solid; HEIGHT: 30.1pt; mso-border-left-alt: solid =
windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D480>
<P class=3DMsoNormal>Enter the social security number or tax =
identification=20
number of the members. <I=20
style=3D"mso-bidi-font-style: =
normal"><o:p></o:p></I></P></TD></TR>
<TR style=3D"HEIGHT: 30.1pt; mso-yfti-irow: 4">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: windowtext 1.5pt solid; WIDTH: 76.8pt; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; HEIGHT: 30.1pt; =
mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D102>
<P class=3DMsoNormal>3</P>
<P class=3DMsoNormal>Address</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: medium none; WIDTH: 5in; PADDING-TOP: 0in; BORDER-BOTTOM: =
windowtext 1.5pt solid; HEIGHT: 30.1pt; mso-border-left-alt: solid =
windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D480>
<P class=3DMsoNormal>Enter the address of each member of the=20
entity.</P></TD></TR>
<TR style=3D"HEIGHT: 8.4pt; mso-yfti-irow: 5">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: windowtext 1.5pt solid; WIDTH: 76.8pt; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; HEIGHT: 8.4pt; =
mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D102>
<P class=3DMsoNormal>4</P>
<P class=3DMsoNormal>Percent Share</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: medium none; WIDTH: 5in; PADDING-TOP: 0in; BORDER-BOTTOM: =
windowtext 1.5pt solid; HEIGHT: 8.4pt; mso-border-left-alt: solid =
windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D480>
<P class=3DMsoNormal>Enter the percent share of the legal entity =
that each=20
member owns.</P></TD></TR>
<TR style=3D"HEIGHT: 30.1pt; mso-yfti-irow: 6; mso-yfti-lastrow: yes">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: windowtext 1.5pt solid; WIDTH: 76.8pt; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; HEIGHT: 30.1pt; =
mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D102>
<P class=3DMsoNormal>5</P>
<P class=3DMsoNormal>Signature Authority</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: medium none; WIDTH: 5in; PADDING-TOP: 0in; BORDER-BOTTOM: =
windowtext 1.5pt solid; HEIGHT: 30.1pt; mso-border-left-alt: solid =
windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D480>
<P class=3DMsoNormal>Check =93YES=94 if the member has signature =
authority for=20
this entity.</P>
<P class=3DMsoNormal>Check =93NO=94 if the member does not have =
signature=20
authority for<SPAN=20
style=3D"mso-spacerun: =
yes"> =20
</SPAN>this entity.</P></TD></TR></TBODY></TABLE></DIV>
<H4>Part C</H4>
<H3>Embedded Legal Entities =96 If any member listed in Part B, Item 7 =
is a legal=20
entity (i.e., part of another partnership, corporation, etc.) lists the =
members=20
of that legal entity in this item. <SPAN=20
style=3D"mso-spacerun: yes"> </SPAN>(If more than one member is a =
legal=20
entity, use a separate, supplemental sheet to provide the requested =
information=20
for each embedded legal entity.) </H3>
<H4>Part C, Items 1-5</H4>
<DIV align=3Dcenter>
<TABLE class=3DMsoNormalTable=20
style=3D"BORDER-RIGHT: medium none; BORDER-TOP: medium none; =
BORDER-LEFT: medium none; BORDER-BOTTOM: medium none; BORDER-COLLAPSE: =
collapse; mso-border-alt: solid windowtext 1.5pt; mso-padding-alt: 0in =
5.4pt 0in 5.4pt; mso-border-insideh: 1.5pt solid windowtext; =
mso-border-insidev: 1.5pt solid windowtext"=20
cellSpacing=3D0 cellPadding=3D0 border=3D1>
<THEAD>
<TR style=3D"HEIGHT: 30.1pt; mso-yfti-irow: 0; mso-yfti-firstrow: =
yes">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: windowtext 1.5pt solid; PADDING-LEFT: 5.4pt; BACKGROUND: =
aqua; PADDING-BOTTOM: 0in; BORDER-LEFT: windowtext 1.5pt solid; WIDTH: =
1in; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1.5pt solid; HEIGHT: =
30.1pt"=20
vAlign=3Dtop width=3D96>
<P class=3DHeading3Cent>Field Name /<BR>Item No.</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: windowtext 1.5pt solid; PADDING-LEFT: 5.4pt; BACKGROUND: =
aqua; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 5in; =
PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1.5pt solid; HEIGHT: 30.1pt; =
mso-border-left-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D480>
<P class=3DHeading3Cent>Instruction</P></TD></TR></THEAD>
<TBODY>
<TR style=3D"HEIGHT: 30.1pt; mso-yfti-irow: 1">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: windowtext 1.5pt solid; WIDTH: 1in; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; HEIGHT: 30.1pt; =
mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D96>
<P class=3DMsoNormal>Part C</P>
<P class=3DMsoNormal>Embedded Legal Entity Name</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: medium none; WIDTH: 5in; PADDING-TOP: 0in; BORDER-BOTTOM: =
windowtext 1.5pt solid; HEIGHT: 30.1pt; mso-border-left-alt: solid =
windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D480>
<P class=3DMsoNormal>Enter the name of the embedded legal entity =
that is a=20
member of the legal entity entered in Part B.</P>
<P class=3DMsoNormal><o:p> </o:p></P></TD></TR>
<TR style=3D"HEIGHT: 30.1pt; mso-yfti-irow: 2">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: windowtext 1.5pt solid; WIDTH: 1in; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; HEIGHT: 30.1pt; =
mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D96>
<P class=3DMsoNormal>1</P>
<P class=3DMsoNormal>Member=92s Name</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: medium none; WIDTH: 5in; PADDING-TOP: 0in; BORDER-BOTTOM: =
windowtext 1.5pt solid; HEIGHT: 30.1pt; mso-border-left-alt: solid =
windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D480>
<P class=3DMsoNormal>Enter the names of the members making up the =
legal=20
entity listed in<SPAN style=3D"mso-spacerun: yes"> =
</SPAN>Part C. <I=20
style=3D"mso-bidi-font-style: normal">(This could be a person =
or<SPAN=20
style=3D"mso-spacerun: yes"> </SPAN>legal=20
entity.)<o:p></o:p></I></P></TD></TR>
<TR style=3D"HEIGHT: 30.1pt; mso-yfti-irow: 3">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: windowtext 1.5pt solid; WIDTH: 1in; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; HEIGHT: 30.1pt; =
mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D96>
<P class=3DMsoNormal>2</P>
<P class=3DMsoNormal>Social Security/Tax ID Number</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: medium none; WIDTH: 5in; PADDING-TOP: 0in; BORDER-BOTTOM: =
windowtext 1.5pt solid; HEIGHT: 30.1pt; mso-border-left-alt: solid =
windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D480>
<P class=3DMsoNormal>Enter the social security number or tax =
identification=20
number of the members. <I=20
style=3D"mso-bidi-font-style: =
normal"><o:p></o:p></I></P></TD></TR>
<TR style=3D"HEIGHT: 30.1pt; mso-yfti-irow: 4">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: windowtext 1.5pt solid; WIDTH: 1in; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; HEIGHT: 30.1pt; =
mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D96>
<P class=3DMsoNormal>3</P>
<P class=3DMsoNormal>Address</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: medium none; WIDTH: 5in; PADDING-TOP: 0in; BORDER-BOTTOM: =
windowtext 1.5pt solid; HEIGHT: 30.1pt; mso-border-left-alt: solid =
windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D480>
<P class=3DMsoNormal>Enter the address of each =
member(s).</P></TD></TR>
<TR style=3D"HEIGHT: 30.1pt; mso-yfti-irow: 5">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: windowtext 1.5pt solid; WIDTH: 1in; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; HEIGHT: 30.1pt; =
mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D96>
<P class=3DMsoNormal>4</P>
<P class=3DMsoNormal>Percent Share</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: medium none; WIDTH: 5in; PADDING-TOP: 0in; BORDER-BOTTOM: =
windowtext 1.5pt solid; HEIGHT: 30.1pt; mso-border-left-alt: solid =
windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D480>
<P class=3DMsoNormal>Enter the percent share of the legal entity =
that each=20
member owns.</P></TD></TR>
<TR style=3D"HEIGHT: 30.1pt; mso-yfti-irow: 6; mso-yfti-lastrow: yes">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: windowtext 1.5pt solid; WIDTH: 1in; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; HEIGHT: 30.1pt; =
mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D96>
<P class=3DMsoNormal>5</P>
<P class=3DMsoNormal>Signature Authority</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: medium none; WIDTH: 5in; PADDING-TOP: 0in; BORDER-BOTTOM: =
windowtext 1.5pt solid; HEIGHT: 30.1pt; mso-border-left-alt: solid =
windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D480>
<P class=3DMsoNormal>Check =93YES=94 if the member has signature =
authority for=20
this entity.</P>
<P class=3DMsoNormal>Check =93NO=94 if the member does not have =
signature=20
authority for<SPAN=20
style=3D"mso-spacerun: =
yes"> =20
</SPAN>this entity.</P></TD></TR></TBODY></TABLE></DIV>
<H4>Part D</H4>
<H3>Embedded Legal Entities =96 If any member listed in Part C, Item 11 =
is a legal=20
entity (i.e., part of another partnership, corporation, etc.) list the =
members=20
of that legal entity in this item.<SPAN style=3D"mso-spacerun: =
yes"> =20
</SPAN>(If more than one member is a legal entity, use a separate, =
supplemental=20
sheet to provide the requested information for each embedded legal =
entity.)</H3>
<H4>Part D, Items 1-5</H4>
<DIV align=3Dcenter>
<TABLE class=3DMsoNormalTable=20
style=3D"BORDER-RIGHT: medium none; BORDER-TOP: medium none; =
BORDER-LEFT: medium none; BORDER-BOTTOM: medium none; BORDER-COLLAPSE: =
collapse; mso-border-alt: solid windowtext 1.5pt; mso-padding-alt: 0in =
5.4pt 0in 5.4pt; mso-border-insideh: 1.5pt solid windowtext; =
mso-border-insidev: 1.5pt solid windowtext"=20
cellSpacing=3D0 cellPadding=3D0 border=3D1>
<THEAD>
<TR style=3D"HEIGHT: 30.1pt; mso-yfti-irow: 0; mso-yfti-firstrow: =
yes">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: windowtext 1.5pt solid; PADDING-LEFT: 5.4pt; BACKGROUND: =
aqua; PADDING-BOTTOM: 0in; BORDER-LEFT: windowtext 1.5pt solid; WIDTH: =
81pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1.5pt solid; HEIGHT: =
30.1pt"=20
vAlign=3Dtop width=3D108>
<P class=3DHeading3Cent>Fld Name /<BR>Item No.</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: windowtext 1.5pt solid; PADDING-LEFT: 5.4pt; BACKGROUND: =
aqua; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 351pt; =
PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1.5pt solid; HEIGHT: 30.1pt; =
mso-border-left-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D468>
<P class=3DHeading3Cent>Instruction</P></TD></TR></THEAD>
<TBODY>
<TR style=3D"HEIGHT: 30.1pt; mso-yfti-irow: 1">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: windowtext 1.5pt solid; WIDTH: 81pt; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; HEIGHT: 30.1pt; =
mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D108>
<P class=3DMsoNormal>Part D</P>
<P class=3DMsoNormal>Embedded Legal Entity Name</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: medium none; WIDTH: 351pt; PADDING-TOP: 0in; BORDER-BOTTOM: =
windowtext 1.5pt solid; HEIGHT: 30.1pt; mso-border-left-alt: solid =
windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D468>
<P class=3DMsoNormal>Enter the name of the embedded legal entity =
that is a=20
member of the legal entity entered in Part C.</P>
<P class=3DMsoNormal><o:p> </o:p></P></TD></TR>
<TR style=3D"HEIGHT: 30.1pt; mso-yfti-irow: 2">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: windowtext 1.5pt solid; WIDTH: 81pt; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; HEIGHT: 30.1pt; =
mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D108>
<P class=3DMsoNormal>1</P>
<P class=3DMsoNormal>Member=92s Name</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: medium none; WIDTH: 351pt; PADDING-TOP: 0in; BORDER-BOTTOM: =
windowtext 1.5pt solid; HEIGHT: 30.1pt; mso-border-left-alt: solid =
windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D468>
<P class=3DMsoNormal>Enter the names of the members making up the =
legal=20
entity listed in Part D. <I style=3D"mso-bidi-font-style: =
normal">(This=20
could be a person or a legal entity.)<o:p></o:p></I></P></TD></TR>
<TR style=3D"HEIGHT: 30.1pt; mso-yfti-irow: 3">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: windowtext 1.5pt solid; WIDTH: 81pt; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; HEIGHT: 30.1pt; =
mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D108>
<P class=3DMsoNormal>2</P>
<P class=3DMsoNormal>Social Security/ Tax ID Number</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: medium none; WIDTH: 351pt; PADDING-TOP: 0in; BORDER-BOTTOM: =
windowtext 1.5pt solid; HEIGHT: 30.1pt; mso-border-left-alt: solid =
windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D468>
<P class=3DMsoNormal>Enter the social security number or tax =
identification=20
number of the member(s).<I=20
style=3D"mso-bidi-font-style: =
normal"><o:p></o:p></I></P></TD></TR>
<TR style=3D"HEIGHT: 30.1pt; mso-yfti-irow: 4">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: windowtext 1.5pt solid; WIDTH: 81pt; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; HEIGHT: 30.1pt; =
mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D108>
<P class=3DMsoNormal>3</P>
<P class=3DMsoNormal>Address</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: medium none; WIDTH: 351pt; PADDING-TOP: 0in; BORDER-BOTTOM: =
windowtext 1.5pt solid; HEIGHT: 30.1pt; mso-border-left-alt: solid =
windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D468>
<P class=3DMsoNormal>Enter the address of each =
member(s).</P></TD></TR>
<TR style=3D"HEIGHT: 30.1pt; mso-yfti-irow: 5">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: windowtext 1.5pt solid; WIDTH: 81pt; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; HEIGHT: 30.1pt; =
mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D108>
<P class=3DMsoNormal>4</P>
<P class=3DMsoNormal>Percent Share</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: medium none; WIDTH: 351pt; PADDING-TOP: 0in; BORDER-BOTTOM: =
windowtext 1.5pt solid; HEIGHT: 30.1pt; mso-border-left-alt: solid =
windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D468>
<P class=3DMsoNormal>Enter the percent share of the entity that =
each member=20
owns.</P></TD></TR>
<TR style=3D"HEIGHT: 30.1pt; mso-yfti-irow: 6; mso-yfti-lastrow: yes">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: windowtext 1.5pt solid; WIDTH: 81pt; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; HEIGHT: 30.1pt; =
mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D108>
<P class=3DMsoNormal>5</P>
<P class=3DMsoNormal>Signature Authority</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: medium none; WIDTH: 351pt; PADDING-TOP: 0in; BORDER-BOTTOM: =
windowtext 1.5pt solid; HEIGHT: 30.1pt; mso-border-left-alt: solid =
windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D468>
<P class=3DMsoNormal>Check =93YES=94 if the member has signature =
authority for=20
this entity.</P>
<P class=3DMsoNormal>Check =93NO=94 if the member does not have =
signature=20
authority for<SPAN=20
style=3D"mso-spacerun: =
yes"> =20
</SPAN>this entity.</P></TD></TR></TBODY></TABLE></DIV>
<P class=3DMsoNormal><B style=3D"mso-bidi-font-weight: normal"><I=20
style=3D"mso-bidi-font-style: normal"><SPAN=20
style=3D"FONT-FAMILY: Arial"><o:p> </o:p></SPAN></I></B></P>
<P class=3DMsoNormal><B style=3D"mso-bidi-font-weight: normal"><I=20
style=3D"mso-bidi-font-style: normal">Part E, Items 1-6 <SPAN=20
style=3D"mso-spacerun: yes"> </SPAN>Minor Members or=20
Shareholders<o:p></o:p></I></B></P>
<TABLE class=3DMsoTableGrid=20
style=3D"BORDER-RIGHT: medium none; BORDER-TOP: medium none; =
MARGIN-LEFT: 5.4pt; BORDER-LEFT: medium none; BORDER-BOTTOM: medium =
none; BORDER-COLLAPSE: collapse; mso-border-alt: solid windowtext 1.5pt; =
mso-padding-alt: 0in 5.4pt 0in 5.4pt; mso-border-insideh: 1.5pt solid =
windowtext; mso-border-insidev: 1.5pt solid windowtext; =
mso-yfti-tbllook: 480"=20
cellSpacing=3D0 cellPadding=3D0 border=3D1>
<THEAD>
<TR style=3D"mso-yfti-irow: 0; mso-yfti-firstrow: yes">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: windowtext 1.5pt solid; PADDING-LEFT: 5.4pt; BACKGROUND: =
aqua; PADDING-BOTTOM: 0in; BORDER-LEFT: windowtext 1.5pt solid; WIDTH: =
79.85pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1.5pt solid"=20
vAlign=3Dtop width=3D106>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: center" =
align=3Dcenter><B=20
style=3D"mso-bidi-font-weight: normal">Fld Name / Item=20
No.<o:p></o:p></B></P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: windowtext 1.5pt solid; PADDING-LEFT: 5.4pt; BACKGROUND: =
aqua; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 357.55pt; =
PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1.5pt solid; =
mso-border-left-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D477>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: center" =
align=3Dcenter><B=20
style=3D"mso-bidi-font-weight: =
normal">Instruction<o:p></o:p></B></P></TD></TR></THEAD>
<TBODY>
<TR style=3D"mso-yfti-irow: 1">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: windowtext 1.5pt solid; WIDTH: 79.85pt; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; mso-border-top-alt: solid =
windowtext 1.5pt"=20
vAlign=3Dtop width=3D106>
<P class=3DMsoNormal><SPAN style=3D"mso-spacerun: =
yes"> </SPAN>Minor=20
members </P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: medium none; WIDTH: 357.55pt; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; mso-border-left-alt: solid =
windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D477>
<P class=3DMsoNormal>If none of the members listed Parts A-D is a =
minor,=20
check =93N/A=94 (not applicable), then GO TO Part F.</P></TD></TR>
<TR style=3D"mso-yfti-irow: 2">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: windowtext 1.5pt solid; WIDTH: 79.85pt; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; mso-border-top-alt: solid =
windowtext 1.5pt"=20
vAlign=3Dtop width=3D106>
<P class=3DMsoNormal>1 =96 5</P>
<P class=3DMsoNormal>Minor Members or Shareholders</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: medium none; WIDTH: 357.55pt; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; mso-border-left-alt: solid =
windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D477>
<P class=3DMsoNormal>If any member listed in Parts A-D is a minor, =
provide=20
the following information about that member:</P>
<P class=3DMsoNormal><o:p> </o:p></P>
<P class=3DMsoNormal style=3D"MARGIN-LEFT: 0.25in"><SPAN=20
style=3D"mso-spacerun: yes"> </SPAN>1)<SPAN=20
style=3D"mso-spacerun: yes"> </SPAN>Minor=92s name</P>
<P class=3DMsoNormal style=3D"MARGIN-LEFT: 0.25in"><SPAN=20
style=3D"mso-spacerun: yes"> </SPAN><SPAN=20
style=3D"mso-spacerun: yes"> </SPAN>2)<SPAN=20
style=3D"mso-spacerun: yes"> </SPAN>Minor=92s date of =
birth</P>
<P class=3DMsoNormal=20
style=3D"MARGIN-LEFT: 45pt; TEXT-INDENT: -0.25in; tab-stops: list =
45.0pt; mso-list: l3 level1 lfo2"><![if !supportLists]><SPAN=20
style=3D"mso-list: Ignore">3)<SPAN=20
style=3D"FONT: 7pt 'Times New =
Roman'"> =20
</SPAN></SPAN><![endif]><SPAN style=3D"mso-spacerun: =
yes"> </SPAN>Name=20
of the minor=92s parent or guardian</P>
<P class=3DMsoNormal=20
style=3D"MARGIN-LEFT: 45pt; TEXT-INDENT: -0.25in; tab-stops: list =
22.75pt; mso-list: l3 level1 lfo2"><![if !supportLists]><SPAN=20
style=3D"mso-list: Ignore">4)<SPAN=20
style=3D"FONT: 7pt 'Times New =
Roman'"> =20
</SPAN></SPAN><![endif]><SPAN=20
style=3D"mso-spacerun: yes"> </SPAN>Address of the parent or=20
guardian</P>
<P class=3DMsoNormal=20
style=3D"MARGIN-LEFT: 45pt; TEXT-INDENT: -0.25in; tab-stops: list =
45.0pt; mso-list: l3 level1 lfo2"><![if !supportLists]><SPAN=20
style=3D"mso-list: Ignore">5)<SPAN=20
style=3D"FONT: 7pt 'Times New =
Roman'"> =20
</SPAN></SPAN><![endif]>Taxpayer ID number of the parent or =
guardian </P>
<P class=3DMsoNormal=20
style=3D"MARGIN-LEFT: 66.6pt; TEXT-INDENT: =
-48.6pt"><o:p> </o:p></P>
<P class=3DMsoNormal style=3D"MARGIN-LEFT: 66.6pt; TEXT-INDENT: =
-48.6pt"><SPAN=20
style=3D"mso-spacerun: yes"> </SPAN><B=20
style=3D"mso-bidi-font-weight: normal">Note:</B> If the complete =
taxpayer ID=20
number is already on file at </P>
<P class=3DMsoNormal style=3D"MARGIN-LEFT: 66.6pt; TEXT-INDENT: =
-48.6pt"><B=20
style=3D"mso-bidi-font-weight: normal"><SPAN=20
style=3D"mso-spacerun: =
yes"> &n=
bsp;=20
</SPAN></B>FSA, only the last 4 digits are required.</P></TD></TR>
<TR style=3D"mso-yfti-irow: 3; mso-yfti-lastrow: yes">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: windowtext 1.5pt solid; WIDTH: 79.85pt; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; mso-border-top-alt: solid =
windowtext 1.5pt"=20
vAlign=3Dtop width=3D106>
<P class=3DMsoNormal>6(a) =96 6(d)</P>
<P class=3DMsoNormal>Separate Status of Minors =85</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: medium none; WIDTH: 357.55pt; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; mso-border-left-alt: solid =
windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D477>
<P class=3DMsoNormal=20
style=3D"MARGIN-LEFT: 13.75pt; TEXT-INDENT: -13.75pt; mso-list: l5 =
level1 lfo6"><![if !supportLists]><SPAN=20
style=3D"mso-list: Ignore">a)<SPAN=20
style=3D"FONT: 7pt 'Times New Roman'"> =20
</SPAN></SPAN><![endif]>Check =93YES=94 if any minor listed in =
Part E is a=20
producer on a farm and the parent or guardian has no =
interest.<SPAN=20
style=3D"mso-spacerun: yes"> </SPAN>Check =93NO=94 if the =
minor is a=20
producer on a farm and the parent or guardian has an interest in =
the=20
farming operation.</P>
<P class=3DMsoNormal><o:p> </o:p></P>
<P class=3DMsoNormal>b)<SPAN style=3D"mso-spacerun: yes"> =
</SPAN>Check=20
=93YES=94 if the minor listed in Part E maintains a separate </P>
<P class=3DMsoNormal><SPAN=20
style=3D"mso-spacerun: yes"> =
</SPAN>household=20
from the parent or guardian and personally carries out all </P>
<P class=3DMsoNormal><SPAN=20
style=3D"mso-spacerun: yes"> =
</SPAN>farming=20
activities with respect to the minor=92s own farming </P>
<P class=3DMsoNormal><SPAN=20
style=3D"mso-spacerun: yes"> =
</SPAN>operation,=20
including maintaining separate accounting.<SPAN=20
style=3D"mso-spacerun: yes"> </SPAN>Check =93NO=94 </P>
<P class=3DMsoNormal><SPAN=20
style=3D"mso-spacerun: yes"> =
</SPAN>if the=20
minor does not maintain a separate household from the parent </P>
<P class=3DMsoNormal><SPAN=20
style=3D"mso-spacerun: yes"> =
</SPAN>or=20
guardian and does not personally carry out all farming activities =
</P>
<P class=3DMsoNormal><SPAN=20
style=3D"mso-spacerun: yes"> =
</SPAN>with=20
respect to the minor=92s own farming operation, including </P>
<P class=3DMsoNormal><SPAN=20
style=3D"mso-spacerun: yes"> =20
</SPAN>maintaining separate accounting</P>
<P class=3DMsoNormal><o:p> </o:p></P>
<P class=3DMsoNormal>c)<SPAN style=3D"mso-spacerun: yes"> =
</SPAN>Check=20
=93YES=94 if the minor listed in Part E who is represented by a =
<SPAN=20
style=3D"mso-spacerun: yes"> </SPAN></P>
<P class=3DMsoNormal><SPAN=20
style=3D"mso-spacerun: yes"> =
</SPAN>court-appointed=20
guardian or conservator, live in a household other </P>
<P class=3DMsoNormal><SPAN=20
style=3D"mso-spacerun: yes"> </SPAN>than =
the=20
parents=92 household(s), and have a vested ownership in the </P>
<P class=3DMsoNormal><SPAN=20
style=3D"mso-spacerun: yes"> =
</SPAN>farm.<SPAN=20
style=3D"mso-spacerun: yes"> </SPAN>Check =93NO=94 if the =
minor, who is=20
represented by a court-</P>
<P class=3DMsoNormal><SPAN=20
style=3D"mso-spacerun: yes"> =
</SPAN>appointed=20
guardian or conservator, does not live in a separate </P>
<P class=3DMsoNormal><SPAN=20
style=3D"mso-spacerun: yes"> =
</SPAN>household other=20
than the parents=92 household(s), and does not have a </P>
<P class=3DMsoNormal><SPAN=20
style=3D"mso-spacerun: yes"> </SPAN>vested =
ownership=20
in the farm.<SPAN style=3D"mso-spacerun: yes"> </SPAN></P>
<P class=3DMsoNormal><o:p> </o:p></P>
<P class=3DMsoNormal=20
style=3D"MARGIN-LEFT: 13.75pt; TEXT-INDENT: -13.75pt; mso-list: l4 =
level1 lfo7"><![if !supportLists]><SPAN=20
style=3D"mso-list: Ignore">d)<SPAN=20
style=3D"FONT: 7pt 'Times New Roman'"> =20
</SPAN></SPAN><![endif]>If =93YES=94 is checked for all Items 6(a) =
through=20
6(c), write the name of the minor in the space provided at 6(d).=20
</P></TD></TR></TBODY></TABLE>
<H4>Part F, Items 1-3 Certification</H4>
<TABLE class=3DMsoTableGrid=20
style=3D"BORDER-RIGHT: medium none; BORDER-TOP: medium none; =
MARGIN-LEFT: 5.4pt; BORDER-LEFT: medium none; BORDER-BOTTOM: medium =
none; BORDER-COLLAPSE: collapse; mso-border-alt: solid windowtext 1.5pt; =
mso-padding-alt: 0in 5.4pt 0in 5.4pt; mso-border-insideh: 1.5pt solid =
windowtext; mso-border-insidev: 1.5pt solid windowtext; =
mso-yfti-tbllook: 480"=20
cellSpacing=3D0 cellPadding=3D0 border=3D1>
<TBODY>
<TR style=3D"mso-yfti-irow: 0; mso-yfti-firstrow: yes">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: windowtext 1.5pt solid; PADDING-LEFT: 5.4pt; BACKGROUND: =
aqua; PADDING-BOTTOM: 0in; BORDER-LEFT: windowtext 1.5pt solid; WIDTH: =
81pt; PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1.5pt solid"=20
vAlign=3Dtop width=3D108>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: center" =
align=3Dcenter><B=20
style=3D"mso-bidi-font-weight: normal">Field Name/ Item=20
No.<o:p></o:p></B></P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: windowtext 1.5pt solid; PADDING-LEFT: 5.4pt; BACKGROUND: =
aqua; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; WIDTH: 4.95in; =
PADDING-TOP: 0in; BORDER-BOTTOM: windowtext 1.5pt solid; =
mso-border-left-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D475>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: center" =
align=3Dcenter><B=20
style=3D"mso-bidi-font-weight: =
normal">Instruction<o:p></o:p></B></P></TD></TR>
<TR style=3D"mso-yfti-irow: 1">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: windowtext 1.5pt solid; WIDTH: 81pt; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; mso-border-top-alt: solid =
windowtext 1.5pt"=20
vAlign=3Dtop width=3D108>
<P class=3DMsoNormal>1</P>
<P class=3DMsoNormal>Signature (By)</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: medium none; WIDTH: 4.95in; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; mso-border-left-alt: solid =
windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D475>
<P class=3DMsoNormal>An individual member, or an authorized =
representative=20
of the entity identified in Part A, shall sign the=20
certification.</P></TD></TR>
<TR style=3D"mso-yfti-irow: 2">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: windowtext 1.5pt solid; WIDTH: 81pt; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; mso-border-top-alt: solid =
windowtext 1.5pt"=20
vAlign=3Dtop width=3D108>
<P class=3DMsoNormal>2</P>
<P class=3DMsoNormal>Title/</P>
<P class=3DMsoNormal>Relationship</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: medium none; WIDTH: 4.95in; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; mso-border-left-alt: solid =
windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D475>
<P class=3DMsoNormal>If an authorized representative for the =
entity=20
identified in Part A signs this document, use this field to show =
the=20
individual=92s representative capacity.<SPAN=20
style=3D"mso-spacerun: yes"> </SPAN>(For example, =
=93agent=94 or=20
=93attorney-in-fact.=94)</P>
<P class=3DMsoNormal><o:p> </o:p></P></TD></TR>
<TR style=3D"mso-yfti-irow: 3; mso-yfti-lastrow: yes">
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: windowtext 1.5pt solid; WIDTH: 81pt; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; mso-border-top-alt: solid =
windowtext 1.5pt"=20
vAlign=3Dtop width=3D108>
<P class=3DMsoNormal>3 </P>
<P class=3DMsoNormal>Date</P></TD>
<TD=20
style=3D"BORDER-RIGHT: windowtext 1.5pt solid; PADDING-RIGHT: 5.4pt; =
BORDER-TOP: medium none; PADDING-LEFT: 5.4pt; PADDING-BOTTOM: 0in; =
BORDER-LEFT: medium none; WIDTH: 4.95in; PADDING-TOP: 0in; =
BORDER-BOTTOM: windowtext 1.5pt solid; mso-border-left-alt: solid =
windowtext 1.5pt; mso-border-top-alt: solid windowtext 1.5pt"=20
vAlign=3Dtop width=3D475>
<P class=3DMsoNormal>Enter the date the form was=20
signed.</P></TD></TR></TBODY></TABLE>
<P class=3DMsoNormal><o:p> </o:p></P></DIV></BODY></HTML>