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, ." 200601661 .; . \ This form is available electronicall Form A roved. OMS No. Q560-0190 FSA.211 U. S. DEPARTMENT OF AGRICULTURE (07-25-02) Farm Service Agency - Commodity Credit Corporation - Federal Crop Insurance Corporation POWER OF A TIORNEY THE UNDERSIGNED does hereby ap~o\nt (I) _ ~ ~R~q \"\ .~ (5) \. J6\'\ ('. t S L \\ r u 6 program number(s) checked below. Checking any of the checked below: County, State of (4) , the attorney-in-fact to act for in connection with Farm Service Agency and Commodity Credit Corporation FSA or CCC programs does not have any impact as to the FCIC transactions 01. o 2. All current and all future programs. o 3. A. FSA aDd CCC PROGRAMS (Check applicable program numbers) All current programs. 0 6. Noninsured Crop Disaster Assistance Program. o 7. TobacCO programs. o 8. Marketing Assistance Loans and Loan Deficiency Payments. B. Transactions for FSA and CCC Programs (Check applicable program numbers) ~ All actions. 0 5. Making reports. o 2. Signing applications, 0 6. Conducting all agreements, and contracts. marketing assistance o 3. Election of bases and yields loan and LOP except peanut designation transactions. o 9. Conservation programs. covered by Item B4. El TO. Milk Income L~Progratll. 0 4. Designation of peanut O W~~~~ 11. Other (Specify) yield to a farm. o 7. Other (Specify) 0'ti.-.~ ~~ ~ tI~~ f'\~ IC programs and crops. o o Direct and Counter-Cycli~ Program except 2002 peanuts covered by Item A4. 4.-' 2002 Din:(;t and COOIltef..cydi,...l Peanut Program. 5. Peanut Quota Buy-Out Program. 1bis form may also be used to grant authority to an attorney-in-fact to act on the grantor's behalf with respect to certain F Checking any of the FCIC transactions does not have any impact as to the FSA or CCC transactions checked above: C. FCIC CROPS D. TRANSACnON NUMBERS USED BY FClC (Enter "All" or specify each crop arul year) (Check applicable numbers) ~ ~1. All actions. o 2. Making application for insurance. o 3. Reporting crop acreage and notice of damage reports. o 4. Making claim for indemnity. o . 5. Making contract changes. o 6. Other (Specify) 1. 2. 3- 4. This Power of Attorney is valid in all counties in the United States unless otherwise noted. -nlis power of attorney shall remain in full force and effect until (J) written notice of its revocation has been duly served upon FSA; (2) death of the undersigned grantor; or (3) incompetence or incapacitation of the undersigned grantor. The undersigned grantor shall provide separate written notice ofrevocation to the applicable crop insurance agent. This power of attorney shall not be effective until properly executed and served to a FSA Service Center. o .0(0'2005 B. Title C. Date (MM.DD.YITY) D. Identification No. of Entity ate (MM-DD-ITYY) C. Official Position TvV County of (e) 5h.d l.?v I lIowing statement is made in accordance with the Privacy Act of 1974 (5 USC 552a) and Ihe Paperwork Reduction Act of 1995. .s amended. TIle .uthority for requesting the foiiowlng ormation Is The Food Security and Rurellnvestment Act of 2002 (Pub. L. 107.171) and 7 CFR Part 71 8. The Information will be used to leg.lly document yovr opinion to .ppointing an anomey~n-fact, ,dentify the person and authOrities granted to Ihe .ppoint..... FurnIShing Ihe requested inform.tiOn Is voluntary; howevef. failure to furnish the requested information will resuit in the individual or enlffy not be able to act as your .ffomey-ln-fact. This information may be prolllded to othef .~encies, IRS, Department of Justice or olher State and Federal Law enforcement a~encies. and in response to a court ma~istrale oradmin/strebve lribunal. The proVISions of criminal and eivil fraud statutes. including 18 USC 286. 287. 371, 651. 1001: 15 USC 714m: and 31 USC 3729, may be applicable to the information provided. Accordln~ to the Paperwork Reduction Act of 1 995. an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information vnless it displays a valid OMS control numwr. The v.lid OMS control num~er for this informalion collectJon Is 0560-0190. The time required to complete this information collection Is estimated to average .15 minutes per response. including the lime for revieWing instructions. ..a"'hing existing data SOU""'S, gathenng and maintaining the data needed. and completing and revieWing tlie collect,on of information. RETURN THIS COMPLETED FORM TO YOUR COUNTY FSA OFRCE. day of (d) County FSA Office, (b) State of , (e) and (a) The US. Departmeni of Agriculture (USDA) pronibits discrimination in .11 Its programs and activities on the basis of race, cotor, national ori~in, gender. religion. age, disability, political beliefs, sexual onentalion, and marital or family status. (Not all prohibited liases apply to all programs) Persons wllh disabilities who require aitemalive means for communication of program mformation (Breme, large print, audiotape, etc.) should contact USDA's TARGET Center at (202) 720-2600 (voice and TOO). To me a complaint of discrimination, write USDA. Director. Office of Civil Ri~htS. Room 326-W WhiNen BuildIng. 1400 Independence Avenve. SW, Washington, D.C. 20250-9410 or calt (202) 720--5964 (voice or TOO). USDA is an equal opportunity provider and employer.