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U.S. Department of Agriculture NRCS-CPA-41A <br />Natural Resources Conservation Service 1212076 <br />❑ Socially Disadvantaged Farmer or Rancherx <br />❑ Veteran Farmer or Rancher" <br />© Not Applicable <br />Definitions are provided below. For more information please go to this Web site: <br />ht fp:/lwww. irltool. sc. agov. usda. go v/ <br />The Landowner agrees that it is submitting this application in furtherance of the Entity's application to <br />participate in the Agricultural Land Easement (ALE) component of the Agricultural Conservation Easement <br />Program (ACEP). The Entity becomes a "Participant" in ACEP only if NRCS enters into an ALE -agreement <br />with the Entity to provide cost -share assistance for the purchaseof Agricultural Land Easements, which may <br />include the offered parcel. However, nothing in this application obligates the United States or the Entity to <br />purchase all or any of the Agricultural Land Easements listed on the Parcel Sheets attached toEntity's <br />application including this parcel. To identify and differentiate roles and responsibilities under ACEP should <br />the application be funded, the undersigned Entity shall hereafter be referred to as the "Participants" and <br />Landowners shall hereafter be referred to as "Landowners." The Participants and Landowners understand <br />that unless an Entity is certified by NRCS, acquiring an Agricultural Land Easement prior to approval of the <br />Agricultural Land Easement deed, appraisal, and title causes the Agricultural Land Easement be ineligible <br />for ACEP cost -share assistance. An Entity may only be certified by the Chief of NRCS. <br />The Participants and Landowners acknowledge that highly erodible land conservation/wetland conservation, <br />adjusted gross income certifications, and member information for all landowners are on file with the <br />appropriate USDA service center agency and are up to date The Landowner must complete and file Form <br />CCC -901, "Member's Information", or its equivalent, if the Landowner is classified as a legal entity or joint <br />operation by the U.S. Department of Agriculture (USDA) under 7CFR part 1400. The Farm Service Agency <br />(FSA) must be timely notified in writing of any changes to the member's information provided, including <br />changes in membership due to death or otherwise as provided in 7 CFR Part 1400. <br />It is the responsibility of the Participants and Landowners to provide accurate data to support all items <br />addressed in this application at the request of NRCS. Participants and Landowners acknowledge that NRCS <br />is relying upon the veracity of the information submitted for purposes of awarding Federal funds and that the <br />submittal of false information may be subject to criminal or civil fraud statutes. <br />Entity Initial <br />12.❑- I certify that the Entity has its own cash resources to provide the Estimated Entity Non -Federal cash <br />contribution to this ALE stated in 10.B. above. <br />13. - For non -certified entities: I, Entity, have provided Landowner a copy of the United States Secretsof <br />Agriculture's required minimum deed terms and conditions for an Agricultural Land Easement.ry <br />14. - For certified entities: I, Entity, have provided Landowner a copy of the United States standard <br />Right of Enforcement clause that must be included in the Agricultural Land Easement. <br />Signature of Authorized Ent! epresentative Date <br />La downer Initial <br />16. ❑ - I, Landowner, am aware that the United States has requirements that must be addressed in the <br />Agricultural Land Easement deed as a condition of providing Federal funds for the acquisition of the <br />easement. I have received a copy of the appropriate set of the United States required deed terms and <br />conditions based on the Entity type indicated above (Item 13 or 14). <br />Signature of Authorized Landowner Representative Date <br />NONDISCRIMINATION STATEMENT <br />The U.S. Department of Agriculture (USDA) prohibits discrimination against its customers. If you believe you experienced <br />discrimination when obtaining services from USDA, participating in a USDA program, or participating in a program that <br />receives financial assistance from USDA, you may file a complaint with USDA. Information about how to file a <br />discrimination complaint is available from the Office of the Assistant Secretary for Civil Rights. <br />