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FSA-2465
(12-31-07)
OMB Control No. 0560-0236
OMB Expiration Date: 07/31/2020
(See Page 2 for Privacy Act and Paperwork Reduction Act Statements)
U.S. DEPARTMENT OF AGRICULTURE
Position 1
Farm Service Agency
ASSIGNMENT, ACCEPTANCE, AND RELEASE
(Wood or Mohair)
1. WHEREAS the United States acting through the U.S. Department of Agriculture, Farm Service Agency ("Government"), is
the holder and owner of a perfected security interest in, or lien on, certain wool or mohair produced, or to be produced during the
(a)
marketing year by (b)
(“Producer”).
2. WHEREAS Producer desires to dispose of all or part of said wool or mohair to or through (a)
(Purchaser or Consignee ("Broker")), and
3. WHEREAS, the Producer and the Broker have requested that Government release its security interest in, or lien on, said wool
or mohair in order that a consignment or sale may be consummated, and
4. WHEREAS, the parties agree to the assignment to the Government of (a) the proceeds of any advance made or to be made on
the wool or mohair by the Broker, less necessary costs for shipping, handling, processing, and marketing, and (b) the proceeds of
the sale of the wool or mohair, less any remaining costs for shipping, handling, processing and marketing, and less the amount of
any advance made by the Broker against the wool or mohair, including interest:
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) 6329992. 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.
FSA-2465 (12-31-07)
Page 2
5. NOW, THEREFORE, in order to consummate the consignment or sale, (a) the net proceeds of any advance or sale described
herein, or both, shall be and are hereby assigned to The Government, (b) it is hereby agreed that all such net proceeds shall be paid
by checks payable jointly to the Producer and the Government, and (c) in consideration of said assignment and agreement the
Government hereby releases its security interest or lien. This "Assignment, Acceptance and Release" shall not be effective until
executed by all parties.
a. Borrower Signature(s)
b. Date
c. Broker Signature
d. Date
e. Authorized Agency Official Name
f. Authorized Agency Official Title
g. Authorized Agency Official Signature
NOTE:
h. Date
The following statements are made in accordance with the Privacy Act of 1974 (5 USC 552a); the Farm Service Agency (FSA) is authorized by the
Consolidated Farm and Rural Development Act, (7 USC 1921 et seq.), and the regulations promulgated thereunder, to solicit the information requested
on this form. The information requested is necessary for FSA to determine eligibility for financial assistance, service your loan, and conduct statistical
analyses. Supplied information maybe furnished to other Department of Agriculture agencies, the Department of the Treasury, the Department of
Justice or other law enforcement agencies, the Department of Defense, the Department of Housing and Urban Development, the Department of Labor,
the United States Postal Service, or other Federal, State, or local agencies as required or permitted by law. In addition, information may be referred to
interested parties under the Freedom of Information Act, to financial consultants, advisors, lending institutions, packagers, agents, and private or
commercial credit sources, to collection or servicing contractors, to credit reporting agencies, to private attorneys under contract with FSA or the
Department of Justice, to business firms in the trade area that buy chattel or crops or sell them for commission, to Members of Congress or
Congressional staff members, or to courts or adjudicative bodies. Disclosure of the information requested is voluntary. However, failure to disclose
certain items of information requested, including Social Security Number or Federal Tax Identification Number, may result in a delay in the processing of
this request or its rejection.
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 0560-0236. The time required
to complete this information collection is estimated to average 10 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 YOUR COUNTY FSA OFFICE.
File Type | application/pdf |
File Title | This form is available electronically |
Author | liz.ashton |
File Modified | 2020-07-15 |
File Created | 2020-07-15 |