Fld Name /Item No. |
Instruction |
1 Lessee’s Name |
Insert the complete name of the lessee in the space provided. |
2 Lessee’s Social Security or Tax Identification Number |
Enter the social security number of the lessee if an individual, or the tax identification number if an entity. |
3 Lessee’s Address |
Enter the complete address of the lessee, including the zip code. |
4 Effective Date of Lease |
Enter the starting date of the lease. |
5 Date Lease Ends |
Enter the date the lease ends. |
6 Amount of Lease |
Enter the total amount of the lease. |
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Fld Name /Item No. |
Instruction |
1(a) Location |
Enter the address of the leased property if available, a legal description, or approximate location of property if legal description in lengthy, and no street address is available. |
1(b) County |
Enter the name of the county where the leased property is located. |
1© State |
Enter the name of the state where the leased property is located. |
Part B Items 24-25 are completed by the lessee.
Fld Name /Item No. |
Instruction |
24 Lessee’s Signature |
If you are mailing or faxing this form print the form and manually enter your signature. If this form is approved for electronic transmission and you have established credentials with USDA to submit forms electronically, use the buttons provided on the form for transmitting the form to the USDA Servicing office. |
25 Date |
Enter the date you are signing the form. |
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Part B Items 26-29 are for FSA use only.
Fld Name /Item No. |
Instruction |
26 Name of Authorized Agency Official |
Type or print the official name used by the Authorized Agency Official. |
27 Title of Authorized Agency Official |
Type or print the working title of the Authorized Agency Official. |
28 Signature |
The Authorized Agency Official will enter his/her signature in the box. |
29 Date |
The Authorized Agency Official will insert the date he/she signs the form. |
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Part C is for FSA use only.
Fld Name /Item No. |
Instruction |
Special Stipulations |
Enter in narrative form any special stipulations that are to become a part of this lease and which are not covered in the items above. For instance, the due date of payments to be made on the lease could be spelled out in this area. |
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Part D is for FSA use only.
Fld Name /Item No. |
Instruction |
1 Lease Type Code |
Enter the number from the following list that applies to the lease:
01 - Lump Sum 32 – Crop Percentage Farm Buyback 02 – Crop Percentage 33 – Monthly FBB 03 – Monthly 34 – Periodic Payments FBB 04 – Periodic Payments 41 – Lump Sum With Option 21 – Lump Sum Homestead to Purchase (OP) Protection (HP) 42 – Crop Percentage OP 23 – Monthly HP 43 – Monthly OP 24 – Periodic Payments HP 44 – Periodic Payments OP 31 – Lump Sum Farm Buy-Back (FBB) |
2 Lessee Type Code |
Enter the number from the following list that applies to the lease:
01 – Individual 06 – Non-Profit 02 – General Partnership 07 – Association of Farmers 03 – Limited Partnership 08 – Organization of Farmers 04 – Corporation 09 –Beginning Farmer 05 – Public Body 10 - Farmer |
3 Lessee Relationship Code |
Enter the number from the following list that applies to the lease:
01 – Immediate Previous Borrower-Owner 02 – Spouse of Previous Borrower – Owner Actively Engaged in Farming 03 – Child of Previous Borrower-Owner Actively Engaged in Farming 04 – Stockholder of Corporation That Was Previous Borrower-Owner 05 – Immediate Previous Family Size Farm Operator 06 – Operators of Not Larger Than Family-Size Farm 07 – Indian Member of Tribe That Has Jurisdiction 08 – Indian Corporate Entity 09 – Indian Tribe Itself 10 - Unrelated |
4 Lessee Kind Code |
Enter the number from the following list that applies to the lease:
00 – All others 05 – Socially Disadvantaged – Ethnic 06 – Socially Disadvantaged – Gender
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File Type | application/msword |
File Title | Template Users: Select the text for each of the instruction components below and type over it without changing the font type, s |
Author | joseph.pruss |
Last Modified By | joseph.pruss |
File Modified | 2006-04-20 |
File Created | 2006-04-20 |