FSA-2476 Transfer of real estate security/transferee

This form is available electronically.

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 5
Farm Service Agency

FSA-2476
(03-29-12)

TRANSFER OF REAL ESTATE SECURITY
PART A - GENERAL
1. Transferor’s Name

2. Transferee’s Name

3A. Real estate to be transferred

3B. Current value
$

4A. Other property, besides real estate, to be transferred

4B. Current value
$

5. Reasons for transfer

6. Amount in Supervised Bank Account

7. Planned disposition of funds in Supervised Bank Account

$
8. Development to be completed, estimated cost, and source of funds

YES

9A. Prior lien

$

9B. Is consent of prior lienholder required?

10A. Junior lien

$

10B. Is consent of junior lienholder required?

NO

11. Taxes and assessments due and
12. Date transfer to be complete
13. Transferee operating/occupying property. If
payable
“NO” expected Date:
$
14. If property is operated, occupied, or leased by other than transferee, provide terms and conditions of occupancy or lease:

15. Direct debts owed FSA to be transferred:
A.
Loan
Number

B.
Amount

C.
Security

D.
Comment

$
$
$
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.

FSA-2476 (03-29-12)
Page 2 of 2
PART B – AGREEMENTS BETWEEN TRANSFEROR AND TRANSFEREE
Transferor and transferee certify that the agreements reached for the transfer of security are made between transferor and transferee
and the information provided herein is correct and fully understood by each.
1. Total consideration for transfer of security is

$

2. Payment or assumption of prior liens:
3. Payment or assumption of junior liens:
4. Payment of taxes (Including current year's taxes):
5. Assignment of property insurance and paid unearned premiums:
6. Distribution of income from rentals, easements, mineral leases, etc.:
7. Disposition of existing abstracts of Title, Owner's Title Insurance Policy or other title evidence:

8. Expenses to be paid by Transferor:
9. Expenses to be paid by Transferee:
10. Transferee will:

AMOUNT

(a) assume an indebtedness to FSA of

$

(b) assume indebtedness to

$

(c) assume indebtedness to

$

(d) pay transferor (as equity)
(Part B, Item 1 minus, Items 10(a), 10(b), and 10(c))

$

PART C – SIGNATURES
1A. Transferor Signature

1B. Date

2A. Transferee Signature

2B. Date

3A. Authorized Agency Official Name

3C. Signature

NOTE:

3B. Title

3D. Date

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 the Consolidated Farm and Rural Development Act, as amended (7 U.S.C. 1921 et. seq.). The
information will be used to determine eligibility and feasibility for loans and loan guarantees, and servicing of loans and loan guarantees.
The information collected on this form may be disclosed to other Federal, State, and 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 the applicable
Routine Uses identified in the System of Records Notice for USDA/FSA-14, Applicant/Borrower. Providing the requested information is
voluntary. However, failure to furnish the requested information may result in a denial for loans and loan guarantees, and servicing of loans
and loan guarantees. The provisions of criminal and civil fraud, privacy, and other statutes 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
0560-0236. 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 YOUR COUNTY FSA OFFICE.