WA-141 Agreement with Respect to Agricutlural Product Storage O

This form is available electronically. See Page 2 for the Privacy Act and Paperwork Reduction Act Statements.

WA-141 U.S. DEPARTMENT OF AGRICULTURE Form Approved - OMB No. 0581-0305

(07-31-18) Agricultural Marketing Service

License No.

     

Initials

   

AGREEMENT WITH RESPECT TO AGRICULTURAL PRODUCT STORAGE OBLIGATIONS

(a) License No.

     

(b) Assuming License No.

     

(c)

     

, (d)

    

(Entity)

(Type Entity)

currently operates the warehouse(s) (e)

     

(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

(g)

     

now has certain obligations representing

(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 License No.)

(Surviving location city, state)

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;

Agricultural Marketing Service 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.

(m)

     

guarantees storage and delivery of all agricultural

(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 (07-31-18) Page 2 of 2

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 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 document the agreement of the warehouse operator to guarantee the storage and delivery of all agricultural product(s) obligations when merging licenses, as required 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 a valid OMB control number. The valid OMB control number for this information collection is 0581-0305. 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 WAREHOUSE AND COMMODITY MANAGEMENT DIVISION, STOP 9148, P.O. BOX 419205, KANSAS CITY, MO 64141-6205.

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.