Customers who have established electronic access
credentials with USDA may electronically transmit this form to the USDA
servicing office, provided that (1) the customer submitting the form is
the only person required to sign the transaction, or (2) the customer has an
approved Power of Attorney (Form FSA-211) on file with USDA to sign for other
customers for the program and type of transaction represented by this form.
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.
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Fld Name / |
Instruction |
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1 Office Holding Warehouse Receipts |
Enter the FSA office that has the warehouse receipt(s) in custody.
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2 Commodity |
Enter the commodity for the loan. |
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3 Loan No. |
Enter the loan number, if known. |
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4 Warehouse Receipt Number(s) |
Enter warehouse receipt number(s). |
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5 Release to (Name and Address) |
Enter the warehouse name and address including Zip code. |
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6 Date |
Enter date. |
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7 Amount |
Enter repayment amount, if known. |
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8 Amount |
Compute daily amount of interest for the loan quantity to be redeemed and round to the nearest cent, if known. |
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9A Producer (Signature) (By) |
Enter 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. |
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9B Title/ Relationship of the individual |
Enter the title/relationship of the individual, if the individual signing in Item 10A. |
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9C Date Signed |
Enter date signed by producer. |