FSA-2006 Property Owned and Leased

Form Approved - OMB No. 0560-0237 Expiration Date: XX/XX/XXXX This form is available electronically. (See Page 2 for the Privacy Act and the Public Burden Statements.)

FSA-2006 (XX-XX-25)

U.S. DEPARTMENT OF AGRICULTURE Farm Service Agency

Position 3

PROPERTY OWNED AND LEASED

1. Name of Applicant      

A. LAND. Include all land owned, to be owned, or leased.

1A. Owner of Record      

1B. Description      

1C. County      

1D. Farm No.      

1E. Total Acres      

1F. Crop Acres      

1G. Oral/ Written Lease      

1H. Crop Share      

%

1I. Cash Rent

1J. Expiration Date      

$

     

2A. Owner of Record      

2B. Description      

2C. County      

2D. Farm No.      

2E. Total Acres      

2F. Crop Acres      

2G. Oral/ Written Lease      

2H. Crop Share      

2I. Cash Rent

2J. Expiration Date      

%

$

     

3A. Owner of Record      

3B. Description      

3C. County      

3D. Farm No.      

3E. Total Acres      

3F. Crop Acres      

3G. Oral/ Written Lease      

3H. Crop Share      

%

3I. Cash Rent

3J. Expiration Date      

$

     

4A. Owner of Record      

4B. Description      

4C. County      

4D. Farm No.      

4E. Total Acres      

4F. Crop Acres      

4G. Oral/ Written Lease      

4H. Crop Share      

%

4I. Cash Rent

4J. Expiration Date      

$

     

5A. Owner of Record      

5B. Description      

5C. County      

5D. Farm No.      

5E. Total Acres      

5F. Crop Acres      

5G. Oral/ Written Lease      

5H. Crop Share      %

5I. Cash Rent $      

5J. Expiration Date      

Non-Discrimination Statement: 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, 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 State or local Agency that administers the program or contact USDA through the Telecommunications Relay Service at 711 (voice and TTY). 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 https://www.usda.gov/oascr/how-to-file-a-program-discrimination-complaint 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, Mail Stop 9410, 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-2006 (XX-XX-25) Page 2 of 2
B. EQUIPMENT/LIVESTOCK. Include only equipment/livestock to be purchased, currently leased, or to be leased.
1. Owner of Record		2. Description	3. Number of Units	4. Rent $	5. Share %	6. Type of Lease		7. Expiration Date
     		     	     	     	     	     		     
     		     	     	     	     	     		     
     		     	     	     	     	     		     
     		     	     	     	     	     
     		     	     	     	     	     		     
     		     	     	     	     	     		     
     		     	     	     	     	     		     
     		     	     	     	     	     		     
     		     	     	     	     	     		     
     		     	     	     	     	     		     
     		     	     	     	     	     		     
C. CERTIFICATION
I certify that the information provided is true, complete, and correct to the best of my knowledge and is provided in good faith. (Warning: Section 1001 of title 18, United States Code, provides for criminal penalties to those who provide false statements. If any information is found to be false or incomplete, such finding may be grounds for denial of the requested action.)
1. Signature							2. Date      
NOTE:	The following is made in accordance with the Privacy Act of 1974 (5 USC 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 0560-0237. The time required to complete this information collection is estimated to average 30 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.