RD 442-21 Right-of-Way Certificate

Form RD 442-21
(Rev. 12-95)

UNITED STATES DEPARTMENT OF AGRICULTURE
RURAL DEVELOPMENT

FORM APPROVED
OMB NO. 0575-0015

RIGHT- OF - WAY CERTIFICATE

The undersigned,
hereby certifies except as noted in item 4 below:

,

1. That the undersigned has acquired and presently holds continuous and adequate rights-of-way on private lands needed for the
construction, operation, and maintenance of the facilities to be installed, repaired, or enlarged with the proceeds of a loan made or
insured by, and/or a grant from, United States Department of Agriculture and such omissions, defects, or restrictions as may exist
will in no substantial way or manner endanger the value or the operation of the facilities.
2. That the undersigned has acquired the necessary permits, franchises, and authorizations or other instruments by whatsoever name
designated, from public utilities and public bodies, commissions, or agencies authorizing the construction, operation, and maintenance of the facilities upon, along or across streets, roads, highways, and public utilities.
3. That the attached ''Right-of-way Map" shows the location and description of all land and rights-of-way acquired by right of use
or adverse possession and by legal conveyances such as right-of-way or easement deeds, permits, or other instruments.
4. Exceptions:

WITNESS WHEREOF, applicant hereunto affixes its name and corporate seal this
, 20

day of

.

By

Attest:
Title
(Secretary)

(Affix Corporate Seal Here)

Public reporting burden for this collection of information is estimated to average 1 hour 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. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to U.S. Department of Agriculture, Clearance Officer, OIRM, AG Box 7630, Washington, D.C. 20250 Please DO NOT RETURN this form to this
address. Forward to the local USDA office only. You are not required to respond to this collection of information unless it displays a currently valid OMB control number.

RD 442-21 (Rev. 12-95)