Instructions for FSA-211

POWER OF ATTORNEY

The FSA-211, Power of Attorney, is used to appoint someone to act on behalf of another as attorney-in-fact. This document gives another person legal authority to act on your behalf. The person receiving the power to act on your behalf may enter into binding agreements and may create liability for you. The attorney-in-fact's power and responsibilities depend on the specific powers granted in this document.

This form is valid only for certain programs and actions offered by the Commodity Credit Corporation (CCC), Farm Service Agency (FSA), and the Federal Crop Insurance Corporation (FCIC).

Grantors must have their signature witnessed by a FSA employee or notarized by a Notary Public. The completed original form must be submitted in hard copy to the appropriate FSA Service Center.

The original form must be submitted. FSA-211’s received through telefacsimile machines will not be accepted.

The Grantor’s signature must be witnessed by a FSA employee in Item 8 or acknowledged by a Notary Public in Item 9.

Items 8A through 8C and 10(a) through 10(e) are for FSA use only.

Items 9(a) through 9(c) are for use by Notary Public only.

Item No./ Letter	Instruction
(1) Person Granted Authority	Enter the name of the person being granted the authority to act on producer’s behalf.
(2) Address of Person Granted Authority	Enter the address of the person being granted the authority to act on producer’s behalf.
(3) County of Residence of Person Granted Authority	Enter the county of residence of the person being granted the authority to act on producer’s behalf.
(4) State of Residence Of Person Granted Authority	Enter the State of residence of the person being granted the authority to act on producer’s behalf.
(5) Producer or Grantor’s Name	Enter producer’s name (Grantor). If the grantor of the authority is an entity such as a corporation or partnership, enter the name of the entity.
1A through 11A FSA and CCC Programs	Enter a checkmark to indicate the applicable program(s) for which the appointed person will act on producer’s behalf. Enter a checkmark in Item A2 if you want the appointed person to act on producer’s behalf for ALL current and ALL future CCC and FSA programs. Specific FSA and CCC programs not listed may be entered in Item A11.
1B through 7B Transac-tions for FSA and CCC Programs	Enter a checkmark for the applicable FSA and CCC action(s) for which the appointed person will act on producer’s behalf. If you want the appointed person to act on producer’s behalf for ALL actions, enter a checkmark in Item B1. Specific actions not listed may be entered in Item B7.
1C through 4C FCIC Crops	Enter the applicable FCIC crop(s) for which the appointed person will act on producer’s behalf. If you want the appointed person to act on producer’s behalf for ALL FCIC crops, enter “ALL in Item C1”.
1D through 6D Transac- tion Numbers Used by FCIC	Enter a checkmark in the applicable FCIC action(s) for which producer’s want the appointed person to act on their behalf. If you want the appointed person to act on producer’s behalf for ALL FCIC actions, enter a checkmark in Item D1. Specific actions not listed may be entered in Item D6 (Specify).
Authorized Signatures
6A – 6C Author- ized Signatures	If the grantor is an individual, the person granting the authority must sign in Item 6A, and enter effective date (MM-DD-YYYY) in Item 6B. If the grantor is an entity such as a general partnership, trust, joint venture, or other similar entity, and there is no individual already authorized to act for the entity, all members of the entity must sign FSA-211. If the grantor is a corporation and their corporate documents do not provide for redelegation of authority, all officers or members of the entity must sign FSA-211. If there are more than 2 member/officer signatures required: · Check box in Item 6C · Attach completed FSA-211A to complete FSA-211A. Note: See Item 7 if the grantor is an entity, and there is an individual already authorized to act for the entity. Your signature must be witnessed by a FSA employee or acknowledged by a notary public. Signatures not witnessed by a FSA employee or acknowledged by a valid Notary Public will not be accepted.
7A – 7C Grantor’s Signature, Title, and Date	If the grantor is an entity, such as a corporation or partnership, the person or persons granting authority must sign in Item 7A, enter their official title in Item 7B, enter signature date (MM-DD-YYYY) and sign in Item 7C. Note: The signature must be witnessed by a FSA employee or acknowledged by a notary public. Signatures not witnessed by a FSA employee or acknowledged by a valid Notary Public will not be accepted.
*Item 8 is for FSA use only.*
9 Notary Public’s Signature, State of, and County of	Items 9(a) through 9(c). The Notary Public shall enter his/her signature when witnessing the signature of the Grantor unless the signature is witnessed by a FSA employee or a corporate seal of grantor is affixed. If the Notary Public does witness the grantor’s signature, enter the State of in Item 9(b), and County of in Item 9(c).
*Item 10 is for FSA use only.*

Item No./ Letter

Instruction

(1)

Person Granted Authority

Enter the name of the person being granted the authority to act on producer’s behalf.

(2)

Address of Person Granted Authority

Enter the address of the person being granted the authority to act on producer’s behalf.

(3)

County of Residence of Person Granted Authority

Enter the county of residence of the person being granted the authority to act on producer’s behalf.

(4)

State of Residence

Of Person Granted

Authority

Enter the State of residence of the person being granted the authority to act on producer’s behalf.

(5)

Producer or Grantor’s Name

Enter producer’s name (Grantor).

If the grantor of the authority is an entity such as a corporation or partnership, enter the name of the entity.

1A through 11A

FSA and CCC Programs

Enter a checkmark to indicate the applicable program(s) for which the appointed person will act on producer’s behalf. Enter a checkmark in Item A2 if you want the appointed person to act on producer’s behalf for ALL current and ALL future CCC and FSA programs. Specific FSA and CCC programs not listed may be entered in Item A11.

1B through 7B

Transac-tions for FSA and CCC Programs

Enter a checkmark for the applicable FSA and CCC action(s) for which the appointed person will act on producer’s behalf. If you want the appointed person to act on producer’s behalf for ALL actions, enter a checkmark in Item B1. Specific actions not listed may be entered in Item B7.

1C through 4C

FCIC Crops

Enter the applicable FCIC crop(s) for which the appointed person will act on producer’s behalf. If you want the appointed person to act on producer’s behalf for ALL FCIC crops, enter “ALL in Item C1”.

1D through 6D

Transac-

tion Numbers Used by FCIC

Enter a checkmark in the applicable FCIC action(s) for which producer’s want the appointed person to act on their behalf. If you want the appointed person to act on producer’s behalf for ALL FCIC actions, enter a checkmark in Item D1. Specific actions not listed may be entered in Item D6 (Specify).

Authorized Signatures

6A – 6C

Author-

ized Signatures

If the grantor is an individual, the person granting the authority must sign in Item 6A, and enter effective date (MM-DD-YYYY) in Item 6B.

If the grantor is an entity such as a general partnership, trust, joint venture, or other similar entity, and there is no individual already authorized to act for the entity, all members of the entity must sign FSA-211.

If the grantor is a corporation and their corporate documents do not provide for redelegation of authority, all officers or members of the entity must sign FSA-211.

If there are more than 2 member/officer signatures required:

· Check box in Item 6C

· Attach completed FSA-211A to complete FSA-211A.

Note: See Item 7 if the grantor is an entity, and there is an individual already authorized to act for the entity. Your signature must be witnessed by a FSA employee or acknowledged by a notary public. Signatures not witnessed by a FSA employee or acknowledged by a valid Notary Public will not be accepted.

7A – 7C

Grantor’s Signature, Title, and Date

If the grantor is an entity, such as a corporation or partnership, the person or persons granting authority must sign in Item 7A, enter their official title in Item 7B, enter signature date (MM-DD-YYYY) and sign in Item 7C.

Note: The signature must be witnessed by a FSA employee or acknowledged by a notary public. Signatures not witnessed by a FSA employee or acknowledged by a valid Notary Public will not be accepted.

Item 8 is for FSA use only.

Notary Public’s Signature, State of, and County of

Items 9(a) through 9(c). The Notary Public shall enter his/her signature when witnessing the signature of the Grantor unless the signature is witnessed by a FSA employee or a corporate seal of grantor is affixed. If the Notary Public does witness the grantor’s signature, enter the State of in Item 9(b), and County of in Item 9(c).

Item 10 is for FSA use only.

Instructions for FSA-211A

POWER OF ATTORNEY SIGNATURE CONTINUATION SHEET

Grantors use FSA-211A, Power of Attorney Signature Continuation Sheet, when the grantor is an entity, such as a general partnership, joint operation, corporation, limited liability company, or other similar entity which require more than one member’s signature to appoint an attorney-in-fact to act on behalf of the entity.

Grantors must have their signature witnessed by a FSA employee or notarized by a Notary Public. The completed original form must be attached to associated FSA-211, and submitted in hard copy to the appropriate FSA Service Center.

The original form must be submitted. FSA-211A’s received through telefacsimile machines will not be accepted.

The Grantor’s signature (Items 3A, 4A, 5A, 6A, and 7A) must be witnessed by a FSA employee or acknowledged by a Notary Public.

Items other than 3A, 4A, 5A, 6A, and 7A are for FSA and Notary Public use only.

Item No./ Section	Instruction
1 Attorney-in-Fact	Enter the name of the attorney-in-fact from Item 1, FSA-211.
2 Name of Grantor	Enter the name of the entity from Item 5, FSA-211.
Authorized Signatures
3A & 3B Authorized Signature and Date	Each applicable producer or grantor must sign in Item 3A, and enter signature date (MM-DD-YYYY) in Item 3B. NOTE: Use the instructions above for Items 4A and 4B; Items 5A and 5B; 6A and 6B, and 7A and 7B respectively. The Grantor’s signature must be witnessed by a FSA employee or acknowledged by a Notary Public.
Items 3C through 3E are For FSA use only. NOTE: Use the instructions above for Items 4C through 4E; Items 5C through 5E; 6C through 6E; and 7C through 7E respectively.


3F Notary Public’s Signature, State of and County of	Each Notary Public enters their signature, State of, and County of. NOTE: Use the instructions above for Items 4F, 5F, 6F, and 7F respectively.