Submit the original
of the completed form in hard copy or facsimile to the appropriate USDA
servicing office. Customers who have established electronic access
credentials with USDA may electronically transmit this form to the USDA
servicing office, provided that 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.
Applicants must complete all Items.
Field Name / |
Instruction |
1 Name of Applicant |
Enter the applicant’s name. |
A. Land |
Include all land owned, to be owned, or leased. |
1A Owner of Record |
Enter the name of the landlord or owner of the property. |
1B Description |
Enter the general description for each farm or tract rented or leased. |
1C County |
Enter the county in which the property is located. |
1D Farm Number |
Enter the farm number assigned to this property. (Obtain the farm number from the Farm Service Agency, Farm Programs Section.) |
1E Total Acres |
Enter the total acres owned or leased. |
1F Crop Acres |
Enter the total crop acres owned or leased. |
1G Oral/Written Agreement |
Enter “Oral” if this is an oral agreement or lease. Enter “Written” if this is a written lease. |
1H Crop Share |
Enter the crop share amount as a percentage. If you do not crop share, enter N/A. |
1I Cash Rent |
Enter the cash rent payment amount. |
1J Expiration |
Enter the expiration date of the lease. If you are not leasing any land enter N/A. |
2A Owner of Record |
Enter the name of the landlord or owner of the property. |
2B Description |
Enter the general description for each farm or tract rented or leased. |
2C County |
Enter the county in which the property is located. |
2D Farm Number |
Enter the farm number assigned to this property. (Obtain the farm number from the Farm Service Agency, Farm Programs Section.) |
2E Total Acres |
Enter the total acres owned or leased. |
2F Crop Acres |
Enter the total crop acres owned or leased. |
2G Oral/Written Agreement |
Enter “Oral” if this is an oral agreement or lease. Enter “Written” if this is a written lease. |
2H Crop Share |
Enter the crop share amount as a percentage. If you do not crop share, enter N/A. |
2I Cash Rent |
Enter the cash rent payment amount. |
2J Expiration |
Enter the expiration date of the lease. If you are not leasing any land enter N/A. |
3A Owner of Record |
Enter the name of the landlord or owner of the property. |
3B Description |
Enter the general description for each farm or tract rented or leased. |
3C County |
Enter the county in which the property is located. |
3D Farm Number |
Enter the farm number assigned to this property. (Obtain the farm number from the Farm Service Agency, Farm Programs Section.) |
3E Total Acres |
Enter the total acres owned or leased. |
3F Crop Acres |
Enter the total crop acres owned or leased. |
3G Oral/Written Agreement |
Enter “Oral” if this is an oral agreement or lease. Enter “Written” if this is a written lease. |
3H Crop Share |
Enter the crop share amount as a percentage. If you do not crop share, enter N/A. |
3I Cash Rent |
Enter the cash rent payment amount. |
3J Expiration |
Enter the expiration date of the lease. If you are not leasing any land enter N/A. |
4A Owner of Record |
Enter the name of the landlord or owner of the property. |
4B Description |
Enter the general description for each farm or tract rented or leased. |
4C County |
Enter the county in which the property is located. |
4D Farm Number |
Enter the farm number assigned to this property. (Obtain the farm number from the Farm Service Agency, Farm Programs Section.) |
4E Total Acres |
Enter the total acres owned or leased. |
4F Crop Acres |
Enter the total crop acres owned or leased. |
4G Oral/Written Agreement |
Enter “Oral” if this is an oral agreement or lease. Enter “Written” if this is a written lease. |
4H Crop Share |
Enter the crop share amount as a percentage. If you do not crop share, enter N/A. |
4I Cash Rent |
Enter the cash rent payment amount. |
4J Expiration |
Enter the expiration date of the lease. If you are not leasing any land enter N/A. |
5A Owner of Record |
Enter the name of the landlord or owner of the property. |
5B Description |
Enter the general description for each farm or tract rented or leased. |
5C County |
Enter the county in which the property is located. |
5D Farm Number |
Enter the farm number assigned to this property. (Obtain the farm number from the Farm Service Agency, Farm Programs Section.) |
5E Total Acres |
Enter the total acres owned or leased. |
5F Crop Acres |
Enter the total crop acres owned or leased. |
5G Oral/Written Agreement |
Enter “Oral” if this is an oral agreement or lease. Enter “Written” if this is a written lease. |
5H Crop Share |
Enter the crop share amount as a percentage, if you do not crop share enter N/A. |
5I Cash Rent |
Enter the cash rent payment amount. |
5J Expiration |
Enter the expiration date of the lease. If you are not leasing any land enter N/A. |
B. Equipment / Livestock |
Include only equipment/livestock to be purchased, currently leased, or to be leased. |
1 Owner of Record |
Enter the name of the owner of the property. |
2 Description |
Enter the description of the equipment or livestock. |
3 Number of Units |
Enter the number of units of equipment or livestock. |
4 Rent |
Enter the amount of rent you pay for the use of the equipment or livestock. |
5 Share % |
Enter the amount (as a percentage) of the share you receive from the use of the equipment or livestock. |
6 Type of Lease |
Enter “Oral” or “Written” if a lease has been established for the use of the equipment or livestock. |
7 Expiration Date |
Enter the date the oral or written lease expires. If there is no oral or written lease, enter N/A. |
C. Certification |
|
1 Signature |
Enter the applicant’s signature. If faxing or mailing the form, print the form and manually enter your signature. This form is approved for electronic transmission. If you have established credentials with USDA to submit forms electronically, use the buttons provided on the form for transmitting the form to the USDA service office. Electronic submission may only be completed if you are the only person required to sign this form. |
2 Date |
Enter the date the applicant signed the form. |