CMC-L1 929-Cranberries Leased Acreage Form

OMB No. 0581-0189

C RANBERRY MARKETING COMMITTEE

219A Main Street

Wareham, MA 02571

Phone: (508) 291-1510

Fax: (508) 291-1511

LEASED ACREAGE FORM

20__ CROP YEAR

Complete and return this form to the Cranberry Marketing Committee.

LEASED FROM: Lessor Grower No. _________________

Name:

Business Name (or D/B/A):

Address:

Telephone No.:

LEASED TO: Lessee Grower No. _________________

Name:

Business Name (or D/B/A):

Address:

Telephone No.:

LEASE INFORMATION AND TERMS

If this is a total lease of the Lessor’s owned acreage, complete 1(a) through (d). If this is a partial lease, complete 2(a) through (e).

1. TOTAL lease of Lessor’s owned acreage

1. How many acres are being leased? ________ acres.

2. What is the length of this lease? _____________ years.

3. On what date did this lease commence? ______________________ (day/month/year)

4. On what date will this lease terminate? ______________________ (day/month/year)

Note: All production history associated with the acreage being leased will be transferred to the Lessee.

2. PARTIAL lease of Lessor’s owned acreage

1. How many acres are being leased? ________ acres.

2. What is the length of this lease? _____________ years.

3. On what date did this lease commence? ______________________ (day/month/year)

4. On what date will this lease terminate? ______________________ (day/month/year)

5. Indicate the amount of sales history being conveyed (transferred) along with the leased acreage for each of the crop years shown below. Note: Prior crop years’ sales history attributable to the acreage being leased must be transferred.

Crop Year	20___	20___	20___	20___	20___	20___
Sales History

I hereby certify that to the best of my knowledge, the information contained herein is true and accurate.

Lessor’s signature ________________________________ Date __________________

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 OMB 0581-0189 The time required to complete this information collection is estimated to average 20 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.

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov. USDA is an equal opportunity provider, employer, and lender.

CMC L1 (Rev. 9/2016. Destroy previous editions.)