FSA-2476 Transfer of real estate security/transferee

See Page 2 for Privacy Act and Public Burden Statements

This form is available electronically.

U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency

FSA-2476
(Proposal 3)

Form Approved - OMB No. 0560-XXXX
Position 5

TRANSFER OF REAL ESTATE SECURITY
PART A - GENERAL
1. Name of Transferor

2. Name of Transferor

3. Name of Transferee

4. Name of Transferee

5. Reasons for Transfer

6. Amount in Supervised Bank Account 7. Planned Disposition of Funds in Supervised Bank Account
$

8. Development to be Completed, Estimated Cost, and Source of Funds

YES

9A. Prior Lien

$

10A. Junior Lien

$

11. Taxes and Assessments Due and
Payable
$

NO

9B. Is Consent of Prior Lienholder Required?
10B. Is Consent of Junior Lienholder Required?
12. Date Transfer to be Complete 13. Transferee Operating/Occupying Property. If "NO"
expected Date:

14. If Property is Operated, Occupied, or Leased by other than Transferee, provide terms and conditions of occupancy or lease:

15. Other Direct Debts owned to FSA by Transferors and not secured by Real Estate being Transferred:
A. Type of Loan

B. Amount

C. Value of Security

$

$

$

$

$

$

D. Plans for Liquidation

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its program and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status,
familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program. (Not
all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information ( Braille, large print, audiotape, etc.) should contact USDA’s
TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of Discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW., Washington, DC 20250-9410,
or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

FSA-2476 (Proposal 3)

Page 2 of 2

PART B - AGREEMENTS BETWEEN TRANSFERORS AND TRANSFEREES
Transferor and transferee certify that the agreements reached for the transfer of security are made between transferor and transferee
and the information provided herein is correct and fully understood by each.
1. Total consideration for transfer of security is

$

2. Payment or assumption of prior liens:

$

3. Payment or assumption of Junior Liens:

$

4. Payment of Taxes (Including current year's taxes):

$

5. Assignment of Property Insurance and Paid unearned premiums:

$

6. Distribution of income from rentals, easements, mineral leases, etc.:

$

7. Disposition of existing abstracts of Title, Owner's Title Insurance Policy or other Title Evidence:

8. Expenses to be paid by Transferor:

$

9. Expenses to be paid by Transferee:

$
AMOUNT

10. TRANSFEREE WILL:
(a) ASSUME AN INDEBTEDNESS TO FSA OF

$

(b) ASSUME INDEBTEDNESS TO

$

(c) ASSUME INDEBTEDNESS TO

$

(d) PAY TRANSFEROR (AS EQUITY)

$

PART C - SIGNATURES
1A. TRANSFEROR SIGNATURE

1B. Date

2A. Transferee Signature

3B. Date

5A. Authorized Agency Offical Name

5C. Signature

5B. Title

5D. Date

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, (7 USC 1921 et seq.), and the regulations promulgated thereunder, to solicit the information requested on this form. The
information requested is necessary for FSA to determine eligibility for financial assistance, service your loan, and conduct statistical analyses. Supplied information
maybe furnished to other Department of Agriculture agencies, the Department of the Treasury, 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, 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 this request 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-XXXX. The time required to complete this
information collection is estimated to average 15 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.