WA-89 Consent of Surety to Changes

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

WA-89 (10-31-11)

U.S. DEPARTMENT OF AGRICULTURE Farm Service Agency United States Warehouse Act

1. FOR FSA USE ONLY

A. License Number

B. Initials

CONSENT OF SURETY TO CHANGES

     

   

C. Bond Number

(See Page 2 for the Privacy Act and Paperwork Reduction Act Statements.)

     

2. On (a)

     

, (b)

     

(Effective Date (MM-DD-YYYY))

(Principal Legal Entity: Warehouse Operator)

     

,

(Principal Legal Entity: Warehouse Operator)

An individual,

A(n) (c)

     

organized and existing

(Type of Entity)

under the laws of the State of (d)

     

,

A corporation organized and existing under the laws of the State of (e)

     

and having its principal place of business at (f)

     

(City and State)

as principal, and (g)

     

(Surety)

as surety,

entered into a bonding agreement known as a Warehouse Operator's Bond in the penal sum of

(h) $

     

.00, (i)

     

dollars,

(Dollars)

for the continuation of United States Warehouse Act license number (j)

     

covering the facilities at

(k)

     

continuously until canceled; and

(Location)

3. This bond has subsequently been amended as follows:

     

4. FOR CORPORATE ENTITIES
	(a) Principal has made the following change requiring the ATTENTION OF SURETY:
	(b)	     
	(c) duly filed, with the Secretary of State of the State of (d)					     		an amendment to its
	articles of incorporation:
	(e) Changing the name of the corporation to: (f)			     
	(g) Other: (h)		     
	and has provided a copy to the Secretary of Agriculture.

WA-89 (10-31-11) Page 2 of 2

5. FOR ALL OTHER ENTITIES: Changes requiring attention of Surety:
     
6. Principal has applied to the Secretary of Agriculture for an amendment to United States Warehouse Act license
number		     				to reflect this change in licensing.
7. Therefore, be it known that				     
				(Surety)
	agrees to this change and it further agrees to continue the warehouse operator's bond in effect the same as if no changes have been made.
8. Executed this (a)			     		day of (b)		     		.
			(Day)				(Month and Year)

9. Surety:

Surety: (a)

     

By: (b)

     

Witnesses to Signatures of Surety:

Witness: (c)

     

Witness: (e)

     

City and State: (d)

     

City and State: (f)

     

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 amend financial assurance of warehouse operators under the United States Warehouse Act. 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 an OMB control number. The valid OMB control number of 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.