Form 7-2536 Limited Recipient Identification Sheet 2008

7-2536 (07-07)
Bureau of Reclamation

OMB Control No.: 1006-0023
OMB Expiration Date: December 31, 2009

LIMITED RECIPIENT IDENTIFICATION SHEET
For Determining if Your Entity is a Limited Recipient for Reclamation Reform Act of 1982 (RRA) Purposes
[Use of this Sheet is to be initiated by Reclamation only.]
For Reclamation Use Only
Date requested: __________________________________________________________
District name: ___________________________________________________________
Entity name: ____________________________________________________________
TO BE COMPLETED BY ENTITY
(Please refer to the instructions provided on the other side of this form.)
1. Entity name: _________________________________________________________
2. Entity address:

_______________________________________________________

_______________________________________________________
Note: If your entity is a public entity or has a section 501 exemption from the Internal Revenue Service, STOP and contact the
appropriate Reclamation office for additional instructions.
3. Total landholding in this district (in acres): ____________
4. State or country where entity is established or registered: ______________________
YES
NO
5. Did your entity receive Reclamation irrigation water on or before October 1, 1981?
If “YES,” provide the date the entity first received Reclamation irrigation water and the name of the district where that water
was
received: Date __________________________
District: ___________________________________________________
6. Does this entity hold land in any other district(s) subject to the acreage limitation provisions? If so, list the district(s) where land
is held and the number of acres held in the district(s). If you are unsure of whether another district is subject to the acreage
limitation provisions of Federal reclamation law, contact your appropriate Reclamation office. Use attachments if necessary.
District Name
Number of Acres

7. Does this entity wholly own any subsidiaries that hold land in a district subject to the acreage limitation provisions or is this
entity wholly owned by another entity? If so, list the subsidiaries or the parent entity, or attach your organizational structure:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
8. Does this entity ultimately benefit (directly or indirectly) more than 25 natural persons?
Note: Refer to the other side of this form for further guidance on completion of this item.

YES

NO

* If you answered “no” to item 8 above, attach a separate sheet that lists (1) the name of each part owner, and (2) the percentage of interest
each part owner holds in this entity.
* If you answered “yes” above, the entity may be a limited recipient. RRA forms must be completed for any entity that ultimately benefits
more than 25 natural persons and holds (directly or indirectly owns or leases) more than 40 acres westwide (i.e., in the 17 western states).
If the entity meets both of those criteria, ask your district office for the appropriate RRA form(s) with instructions and an RRA
Form 7-21INFO. Complete the appropriate RRA form(s) and submit it to the district office for a determination of your entity's acreage
limitation status and entitlements.
* If you answered “yes” above but the entity does not hold more than 40 acres westwide, while the entity may still be a limited recipient, the
RRA forms requirements do not apply. Contact your district office to determine the entity's acreage limitation status and entitlements in
order to avoid being in noncompliance with the RRA and the Acreage Limitation Rules and Regulations.

Please attest to the following:
I (we) attest that the information provided herein is true, accurate, and complete to the best of my (our) knowledge.
Name:
__________________________________________________________________
Signature:
__________________________________________________________________
Date:
__________________________________________________________________
Address:
__________________________________________________________________
Relationship to entity: _____________________________________________________________
Telephone number where you can be contacted: __________________________________________
RETURN THIS IDENTIFICATION SHEET TO THE ISSUING RECLAMATION OFFICE.
See reverse side for instructions and Paperwork Reduction Act of 1995 and Privacy Act of 1974 system of records information.
LANDHOLDER COPY

Paperwork Reduction Act
This information is being collected to establish landholder compliance with Federal reclamation law. Response to this request is
mandatory in accordance with Public Law 97-293 and 43 CFR 426.18. Public reporting burden for this form is estimated to
average 5 minutes per response. An agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a currently valid Office of Management and Budget (OMB) control number.
Direct comments regarding the burden estimated or any other aspect of these forms to Manager, Land Resources Office,
Code 84-53000, U.S. Bureau of Reclamation, PO Box 25007, Denver CO 80225.

INSTRUCTIONS FOR COMPLETION
GENERAL Instructions
• When Reclamation has identified an entity that may be a limited recipient, Reclamation will determine if the “Limited Recipient
Identification Sheet” (Sheet) should be completed by the entity. Reclamation will send this Sheet directly to the entity.
• Press firmly when writing to ensure that all copies are legible.
• Visit www.usbr.gov/rra for more information.
RECLAMATION Instructions
• “For Reclamation Use Only” block: Complete all information.
• For recordkeeping purposes, retain the top half-sheet copy (“Originator Copy”) of the Sheet at the time of issuance.
• When the entity has completed and returned the Sheet to Reclamation:
o Ensure the Sheet is complete.
o Retain the “Reclamation Copy.”
o Provide the “District Copy” to the appropriate district office.
ENTITY Instructions
• Numbers 1 through 4: Enter the requested information.
• Number 5: Answer the question provided. Enter the date the entity first received Reclamation irrigation water anywhere in the
17 western states, and the name of the district in which that water was received.
• Number 6: Identify land the entity directly or indirectly owns and leases in any other district that is subject to the acreage
limitation provisions.
• Number 7: If the entity has any wholly owned subsidiaries (i.e., subsidiaries that are 100% owned by this entity) and the wholly
owned subsidiary directly or indirectly owns or leases land that is subject to the acreage limitation provisions, list the wholly
owned subsidiaries. If this entity is owned by another entity, list the entity (parent entity) that owns this entity.
• Number 8: Count all natural persons listed as a part owner (or shareholder, stockholder, etc.) for this entity and for any entity that
wholly or partially owns this entity. Once you have (a) counted more than 25 natural persons, or (b) evaluated all associated
entities for part owners (or shareholders, stockholders, etc.), stop and answer this YES/NO question based on the count you have
just completed. Count each natural person only once. (The term “natural person” means a living human being. For acreage
limitation purposes, this includes shareholders specifically named on stock certificates, partners identified by a partnership
agreement, tenants specifically named in landownership documents, etc.) If you answered “no,” this entity is not a limited
recipient. Attach a separate sheet that lists (1) the name of each part owner, and (2) the percentage of interest each listed part
owner holds in this entity. The total interest must equal 100 percent.
• Complete the attestation section (name, signature, date, address, relationship to the entity, and telephone number).
• Retain the “Entity Copy”
• Return the “Reclamation Copy” and the “District Copy” to the Reclamation office that issued this Sheet.
This report is required by Public Law 97-293. Failure to complete this form can result in the determination that your entity
is a limited recipient with a zero acre nonfull-cost entitlement. Information obtained in this form is protected by the Privacy Act
of 1974, system of records notice INTERIOR/WBR-31, and will be used to administer the acreage limitation provisions of
Federal reclamation law. The Secretary of the Interior or the district may require additional information in order to administer
these laws.

7-2536 (07-07)
Bureau of Reclamation

OMB Control No.: 1006-0023
OMB Expiration Date: December 31, 2009

LIMITED RECIPIENT IDENTIFICATION SHEET
For Determining if Your Entity is a Limited Recipient for Reclamation Reform Act of 1982 (RRA) Purposes
[Use of this Sheet is to be initiated by Reclamation only.]
For Reclamation Use Only
Date requested: __________________________________________________________
District name: ___________________________________________________________
Entity name: ____________________________________________________________

Paperwork Reduction Act
This information is being collected to establish landholder compliance with Federal reclamation law. Response to this
request is mandatory in accordance with Public Law 97-293 and 43 CFR 426.18. Public reporting burden for this form is
estimated to average 5 minutes per response. An agency may not conduct or sponsor, and a person is not required to
respond to, a collection of information unless it displays a currently valid Office of Management and Budget (OMB) control
number. Direct comments regarding the burden estimated or any other aspect of these forms to Manager, Land Resources
Office, Code 84-53000, U.S. Bureau of Reclamation, PO Box 25007, Denver CO 80225.

ORIGINATOR COPY