WA-141 Agreement with Respect to Agricutlural Product Storage O

This form is available electronically.

See Page 2 for the Privacy Act and Public Burden Statements.
U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency

WA-141
(11-20-03)

Form Approved - OMB No. 0560-0120

Initials

License No.

AGREEMENT WITH RESPECT TO AGRICULTURAL PRODUCT STORAGE OBLIGATIONS
(a)

(c)

License No.

(b)

Assuming License No.

_______________________________________________________,

(d)

(Entity)

currently operates the warehouse(s)

(e)

(Type Entity)

__________________________________________________________________________
(Common Name of Warehouse(s) and location City, State)

[License No. (f) __________________ ] as a public warehouse under the license number(s) cited issued under the provisions of
the United States Warehouse Act (7 U.S.C. 241-256) (the Act); and
now has certain obligations representing

(g)
(Entity)

agricultural products in this (these) warehouse(s) but has chosen to merge this (these) location(s) with its license
number (h) ____________________

at (i) _____________________________________________________ also licensed
(Surviving location city, state)

(Surviving License No.)

under the United States Warehouse Act; and

(j)

________________________________________________________

has

(Entity)

applied to the Secretary to merge these facilities with the (k)
(Surviving location city, state)

license surviving;

Farm Service Agency is charged with the supervision of warehouses licensed under the Act and desires to make
certain that all storage obligations made by

(l)
(Entity)

for agricultural products stored in this warehouse will be fulfilled.
guarantees storage and delivery of all agricultural

(m)
(Entity)

products obligations according to the terms and conditions of the Act, the regulations, licensing agreements, and warehouse
receipts originally issued at (n)

.
(Old location(s) city, state)

WA-141

Page 2 of 2

(11-20-03)

The warehouse operator has executed this agreement this

(o)

day of (p)
Day

Month / Year

(q)
Entity

(r) By

Officer

(s) Its
Office

(t) Witness

(u) City, State

NOTE: The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a) and the Paperwork Reduction Act of 1995, as amended. The authority
for requesting the following information is the regulations at 7 CFR Part 735. This information may be provided to other agencies, IRS, Department of Justice or
other State and Federal law enforcement agencies, and in response to a court magistrate or administrative tribunal. The provisions of criminal and civil fraud
statutes, including 18 U.S.C. 286, 287, 371, 641, 651, 1001; 1014, and 31 U.S.C. 3729, may be applicable to the information provided.
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. RETURN THIS COMPLETED FORM TO THE KANSAS CITY
COMMODITY OFFICE, POST OFFICE BOX 419205, KANSAS CITY, MO 64141-6205.
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, age, disability,
political beliefs, sexual orientation, and marital or family status. (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 USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence Avenue, SW, Washington, D. C. 20250-9410 or call (202)
720-5964 (voice or TDD). USDA is an equal opportunity provider and employer.