Instructions for FSA-2620

INDIAN TRIBAL LAND ACQUISITION PROGRAM LOAN APPLICATION

This form is used by Tribes and Tribal corporations to apply for FSA direct loan assistance.

The authorization for the information collected on this form is 7 CFR Part 770, "Indian Tribal Land Acquisition Program", and FSA Handbook, 6-FLP, Part 2, "Loans to Indian Tribes and Tribal Corporations."� Information and assistance can be obtained from any USDA Service Center by contacting FSA listed under US Government offices as the USDA Farm Service Agency in your local telephone directory.

Submit the original completed form in hard copy or a facsimile copy to the appropriate FSA servicing office.� A paper or electronic copy of the completed form should be retained by the applicant and a copy filed in the Agency�s case file.�

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.

Tribal or Tribal Corporation must complete Items 1-14 and Item 16, but before signing in Item 23, read Items 20, 21 and 22.

Items 1 - 3

Fld Name / Item No.	Instruction
1 Loan Type	If applicable enter checkmark to show whether request is for new loan or refinance.� Answers to this question determines information needed to complete loan processing.
2 Type of Application	Enter checkmark to indicate whether request is a loan application or servicing application.
3 Date Application Prepared	Enter date information on the form was prepared.

Part A � Applicant�s Information

Items 4-16

Fld Name / Item No.	Instruction
4A Applicant�s Name	Enter name of Tribe or Tribal corporation.
4B Applicant�s Address	Enter address of mail delivery for all Tribe or Tribal corporation correspondence.
4C Applicant�s Tax ID Number	Enter IRS Tax ID or enter exempt in this block.
5 Authorized to Apply as:	Check applicable box or boxes.
6 Authority to Mortgage Provided by:	Check applicable box or boxes.
7A Amount of Previous FSA Loans to this Tribe.	Enter total principal amount of loans previously approved.
7B Total Annual Installment Principal and Interest	Enter the total payment due FSA on an annual basis of all loans payable to FSA.
7C If Delinquent, Amount	Enter the amount of principal and interest behind schedule.

Fld Name / Item No.	Instruction
7D No. of Payments Delinquent	Enter the number of payments delinquent for all outstanding loans.
8A - 8D Other Tribal Obligations	List or attach audited financial statement: A. To whom owed (secured by). B. Amount of original loan. C. Amount of payment. D. Final payment date.
9A Income From Lands Purchased with FSA Loan Funds	Enter the amount of income derived from land previously purchased with loans from the former FmHA or FSA.
9B Income from Lands Already Owned by Tribe or Tribal Corporation	Enter the total income from land rentals or other income of tribe�s ownership.
9C Other Tribal Income	Enter amount of income to the Tribe or Tribal corporation derived from all sources; ie. gaming, Government, rents, etc.
9D Total Income From Which FSA Payments Can be Made	This should include income from all land which has been purchased with FmHA or FSA loan funds and income identified from any other source, if land income is insufficient.

Fld Name / Item No.	Instruction
10A Acres Owned by the Tribe (Including Tribal Corporations)	This information should be available through Bureau of Indian Affairs� (BIA) and should include all land which is held as if in trust as well. These are lands which may produce income for the tribe.
10A (1) In Trust	All land held in trust.
10A (2) In Fee	This is all land owned by the Tribe or Tribal corporation in fee simple title status.� This may be obtained from BIA through the title plant operations.
10A (3) Total Owned by Tribe	This should be equal to item 10A (1)+(2).
10B Acres Owned by Others	This information, if not available through the Tribe, may be available through the BIA.
10B (1) Trust Acres Owned by Individual Native Americans	This information, if not available through the Tribe, may be available through the BIA and includes acres rented by individual Native Americans.
10B (2) Non-Trust Acres Owned by Individual Native Americans	These are the same as owned in fee simple.
10B (3) All Other Acres	All other acres not rented, owned or operated on the reservation.

Fld Name / Item No.	Instruction
10B (4) Total all Ownerships Other Than Tribe or Tribal Corporation	This acreage total should be the sum of Item 10B (1), (2), and (3).
10B (5) Total Acres in the Reservation	This information can be provided by the BIA.
11A - D Current Year's Tribal Land Use Plan	A. Enter number of acres for grazing. B. Enter number of acres for farming. C. Enter number of acres for forestland. D. Enter number of acres used for other purposes (this is all remaining acres not mentioned above).
12A Number of Acres to be Purchased With Loan Funds or Refinanced.	Number of acres to be purchased with loan funds/refinance.� Attach the option for land to be purchased with loan funds.
12B Number of Acres Where 100% Ownership is to be Acquired.	Number of acres to be purchased with loan funds/refinanced in which 100% ownership is to be acquired.
12B (1) - (5) Enter Number of Acres	(1) Enter cropland acres. (2) Enter pasture land acres (3) Enter forestland acres (4) Enter acres to be acquired not fitting into categories listed in items above. (5) Enter total number of acres listed above.

Fld Name / Item No.	Instruction
12C (1a) - (5a) Number of Acres Where� Less Than 100% Ownership to be Acquired.	(1a)� Enter cropland acres equal to 100% i.e. if purchasing 50% interest in 2 acres would list 1-acre as 100% equivalent. (2a)� Enter pasture land acres equal to 100% i.e. if purchasing 50% interest in 2 acres would list 1-acre as 100% equivalent. (3a)� Enter forest land acres equal to 100% i.e. if purchasing 50% interest in 2 acres would list 1-acre as 100% equivalent. ����������������������������������������������������������������������� (4a)� Enter acres which do not fit into Items 12B (1), (2), or (3), if purchasing 50% interest in 2 acres would list 1-acre as 100% equivalent. (5a)� Enter total of Items (1a), (2a), (3a) and (4a) above.
12C (1b) - (5b) Number of Acres Where� Less Than 100% Ownership to be Acquired.	(1b)� Enter total cropland acres.� Example if purchasing 50% interest in 2 acres enter 2 acres. (2b)� Enter total pasture land acres.� Example if purchasing 50% interest in 2 acres enter 2 acres. (3b)� Enter total forest land acres.� Example if purchasing 50% interest in 2 acres enter 2 acres. (4b)� Enter acres which do not fit into Items 12B (1) (2) or (3).� Example purchasing 50% interest in 2 acres enter 2 acres. (5b)� Enter total of Items (1b), (2b), (3b) and (4b) above.
12D Total Acreage Equivalent of 100% Ownership	To determine this figure, enter the acreage equivalent to 100% by taking the percent of interest to be acquired and dividing it into the total acreage optioned.
12E Appraised Value of Land to be Purchased or Refinanced	Enter the market value of the property as determined by an appraisal obtained in accordance with 1-FLP.
13A Refinancing	If not refinancing proceed to Item 14.� If refinancing, attach verification that the seller would not entertain an option until funding could be made available from FSA. For example land may have been lost due to legal action or short sale period.

Fld Name / Item No.	Instruction
13B Refinancing	Attach verification for short term debt purchase of the land i.e. balloon payment or term which could not be met by applicant or modified in order to meet the needs of lender or credit source.
14 Security Offered for This Loan	The applicant should enter checkmark for the manner in which a loan, if approved, would be secured, whether by assignment of all tribal income, mortgage on land to be purchased, or mortgage on land already owned by the Tribe.

Part B for FSA use only.

Fld Name / Item No.	Instruction
16 Certification and Approval	Applicant certifies that the information provided on this form is true and accurate to the best of the applicant's knowledge and belief.

Part C, Items 17-19 for FSA use only.

READ Items 20, 21 and 22 before signing Item 23.

Fld Name / Item No.	Instruction
20 - 22 Required Statements on Page 4	Applicant must read the Statements in Item 20 through 22 before signing this form.
23A - B Applicant or Authorized Representative Acknowledg-ment	Applicant or authorized representative must sign and date this form acknowledging that the information provided on this form is true and accurate to the best of the applicant's knowledge and belief. 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.