Highly Erodible Land and Wetland Conservation Certification (State, Local or Tribal Government)

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Instructions For AD-1026C
LANDLORD OR LANDOWNER EXEMPTION REQUEST 
Landlords or landowners use this form to request an exemption for conservation provisions under USDA programs. 
 
Submit the original of the completed form in hard copy or facsimile to the appropriate FSA servicing office.  
 
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.
 
Landlords must complete Items 1 through 8.
 
Items 1 - 8
Fld. Name/ Item No.
Instruction
1A
State Name
Enter the State name where the farm is located.
1B
County Name
Enter the County name where the farm is located.
2
Landlord or Landowner Information 
Enter the landlord or landowner’s name and address including Zip code.
3
Landlord or Landowner's 
Telephone  Number
Enter the landlord or landowner’s telephone number including area code.
4
Landlord or Landowner's
Identification Number
Enter the landlord or landowner’s social security number or tax ID number.
5A
Farm Number
Enter the Farm Number on which the exemption request is being made.
5B
Tract Number
Enter the tract number for which the exemption is requested.
 
6
Crop Year
Enter the crop year for which the exemption request is being made.
7
Cropland
Enter the number of acres for which the exemption request is being made.
8
Certification
Enter landlord or landowner’s signature and date.
 
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.
 
Items 9 - 10 are for FSA's use only.