Submit the original of the completed form in hard copy or facsimile to the appropriate USDA office. Customers who have established electronic access credentials with USDA may electronically transmit this form to the USDA office, provided the customer submitting the form is the only person required to sign the transaction.
Features for transmitting the form electronically are available to those customers with access credentials only. If you would like to establish online access credentials with USDA, follow the instructions provided at the USDA eForms web site.
FSA will complete Part A. Applicant and joint owners read, with the FSA Official, all Items in Part B. Part C is completed by owners of joint property. Part D is completed by lienholders immediately prior to sale of the listed security.
Part A – Jointly Owned Property – Completed by FSA from current chattel
appraisal.
Fld Name /
|
Instruction |
A1
Description of Property |
Enter a complete description of the jointly owned chattel property. This should include chattel type, make, model, serial number, year, color, weight, age and any other information that specifically identifies the chattel property.
If there is insufficient room on the form to include all jointly owned equipment attach a separate sheet(s) as needed.
|
Part B – Agreement - Completed by the applicant and joint owners.
Fld Name /
|
Instruction |
1- 3 Agreement |
Please read. |
4 Date |
Enter the date the form is signed. |
5 Owner’s Name |
Enter each owner’s name. |
6 Owner’s Signature |
Enter the signature of each owner listed in Item 5.
If faxing or mailing the 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 office. Electronic submission may only be completed if you are the only person required to sign this form. |
7 Undivided Interest |
Enter the undivided interest of each owner listed in Item 5, expressed as a percentage. |
8 Lienholder Name |
Enter the name of any non-FSA lienholder who has a lien on the jointly owned property. |
9 Lienholder Telephone Number |
Enter the telephone number of each lienholder listed in Item 8. |
Part C – Lienholder Information - Completed by the lienholder.
Fld Name /
|
Instruction |
1 Name of Owner |
Enter the name of the applicable owner of the jointly owned property. |
2 Lienholder Name |
Enter the name of the lienholder. |
3 Lienholder Signature |
Enter the lienholder’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. |
4 Date |
Enter the date the lienholder signed this agreement. |
Part D – Lienholder Consent -Completed by Lienholder Immediately Prior to Sale by Government.
|
|
Fld Name /
|
Instruction |
D1 Owner of Jointly Owned Property |
Enter the name(s) of each owner of the jointly owned property. |
D2 Lien- holder’s Name |
Enter the name of the lienholder. |
D3 Lien- holder’s Signature |
Enter the signature of the lienholder consenting to the described property being sold by the Government as provided in Part B of this agreement. |
D4 Date |
Enter the date (MM-DD-YYYY) the lienholder signed this agreement. |
Page
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 | Preferred Customer |
Last Modified By | Cathy.Quayle |
File Modified | 2007-04-25 |
File Created | 2007-04-25 |