WA-84 Power of Attorney (To sell Securities)

This form is available electronically. Form Approved – OMB No. 0560-0120

WA-84 U.S. DEPARTMENT OF AGRICULTURE

(10-31-11) Farm Service Agency

POWER OF ATTORNEY

(TO SELL SECURITIES)

I, (WE) (a)

     

     

of City (b)

     

State (c)

     

do hereby constitute and appoint the Secretary of Agriculture or designated representative as attorney to collect, sell assign, and

transfer certain securities described as follows: (d)

     

     

     

     

such securities having been deposited, in lieu of a security bond, as security for the faithful performance of any and all stipulations of

a certain obligation, entered into under the United States Warehouse Act on (e)

     

     

, Year

    

, which is

hereby made a part hereof, and the undersigned agrees that, in case of any default in the performance of any of the conditions and stipulations of said obligation, the above-named attorney shall have full power to collect said securities or any part thereof, and to sell, assign, and transfer said securities or any part thereof without notice, at public or private sale, free from any equity of redemption, without any appraisement or valuation notice and right to redeem being waived, and to apply the proceeds of such sale or collection, in whole or in part, to the satisfaction of any damages, demands or deficiency arising by reason of such default, as said attorney may deem best, and the undersigned further agrees that authority herein granted is irrevocable. The undersigned ratifies and confirms whatever said attorney shall do on their behalf, and on behalf of their successors, and assigns.

SIGNED AND DATED this (f)

     

day of

     

, Year

    

.

(g) MUST BE ACKNOWLEDGED

Name

     

(h) By

     

(i) Title

     

NOTE:

The following statement is made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a - as amended).  The authority for requesting the information identified on this form is 7 CFR Part 735, 7 CFR Part 1423, 7 CFR Part 1427, the United States Warehouse Act (Pub. L. 106-472), and the Commodity Credit Corporation Charter Act (15 U.S.C. 714 et seq.).  The information will be used to provide a Power of Attorney for individuals or partnerships that have executed form WA-83 - Warehouse Operator’s Bond (For Eligible Securities).  The information collected on this form may be disclosed to other Federal, State, Local government agencies, Tribal agencies, and nongovernmental entities that have been authorized access to the information by statute or regulation and/or as described in applicable Routine Uses identified in the System of Records Notice for USDA/FSA-2, Farm Records File (Automated) and USDA/FSA-3, Consultants File.  Providing the requested information is voluntary.  However, failure to furnish the requested information will result in a determination of ineligibility to obtain new licensing or retain existing licensing under the United States Warehouse Act. 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 0560-0120. 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. The provisions of appropriate criminal and civil fraud, privacy, and other statutes may be applicable to the information provided.  RETURN THIS COMPLETED FORM TO THE KANSAS CITY COMMODITY OFFICE, WAREHOUSE LICENSE AND EXAMINATION DIVISION, STOP 9148, P.O. BOX 419205, KANSAS CITY, MO 64141-6205.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all of its programs 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, political beliefs, genetic information, 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, Assistant Secretary for Civil Rights, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, S.W., Stop 9410, Washington, DC  20250-9410, or call toll-free at (866) 632-9992 (English) or (800) 877-8339 (TDD) or (866) 377-8642 (English Federal-relay) or (800) 845-6136 (Spanish Federal-relay).  USDA is an equal opportunity provider and employer.