Instructions = for CCC-526

Instructions=20 for CCC-926

Average=20 Adjusted Gross Income (AGI) Statement

This=20 certification statement is to be used for 2009 and subsequent=20 years.

This form is used to certify = compliance with=20 the adjusted gross income provision for the receipt of = commodity,=20 conservation and price support program benefits. See page 2 of the form = for=20 eligibility requirements and definitions. =20 Submit the original of the completed form in hard copy or = facsimile to=20 the appropriate USDA servicing office.

Customers = who have=20 established electronic access credentials with USDA may electronically = transmit=20 this form to the USDA servicing office, provided that (1) the = customer=20 submitting the form is the only person required to sign the transaction, = or (2)=20 the customer has an approved Power of Attorney (Form FSA-211) on file = with USDA=20 to sign for other customers for the program and type of transaction = represented=20 by this form.

Features = for=20 transmitting the form electronically are available to those customers = with=20 access credentials only. = To=20 establish online access credentials with USDA, follow the instructions = provided=20 at the USDA eForms web site. =20 Submit this completed form to the = address=20 specified in Item 1.

Complete=20 Items 1 through 8; sign and date in Items 9 through=20 11.

Fld Name /
Item No.

Instruction

1=20

County FSA Office or=20 Service=85

Enter the=20 name, address of the county Farm Service Agency or Service Center = office that=20 this form will be submitted.

2=20

Person or=20 Legal Entity=92s=85

Enter the=20 person or legal entity=92s name and address for commodity, = conservation and=20 price support program benefits.

ID =

No.

Enter the last=20 4 digits the social security or tax identification number of the = person or=20 legal entity represented in Item = 2.

Select the=20 year for which=85

Enter a=20 checkmark next the year for which program benefits are = requested. (Select only=20 one.)

The year=20 selected indicates the 3-year period that will be used in the=20 determination of the average adjusted gross income for payment=20 eligibility.

Average adjusted gross non-farm income of=20 $500,000=85

Average adjusted gross non-farm income of = $500,000 or=20 less for the applicable 3-year period for the program year = selected in=20 Item 4.

Check the=20 appropriate response. = Select=20 A for =93YES=94 or select B for =93NO.=94

Average adjusted gross farm income of = $750,000=85

Average adjusted gross farm income of = $750,000 or less=20 for the applicable 3-year period for the program year selected in = Item=20 4.

Check the=20 appropriate response. = Select=20 A for =93YES=94 or select B for =93NO.=94

Average adjusted gross non-farm income of $1=20 million=85

Average adjusted gross non-farm income of $1 = million or=20 less for the applicable 3-year period for the program year = selected in=20 Item 4.

Check the=20 appropriate response. Select A for =93YES=94 or select = B for=20 =93NO.=94

Was the Average adjusted gross farm = income=85

Was the Average adjusted gross farm income = for the=20 applicable 3-year period selected in Item 4 at least 66.66% of the = average=20 adjusted gross income (both farm and nonfarm income). Check the appropriate = response. Select A for =93YES=94 = or select B for=20 =93NO.=94

If = =93YES=94 is=20 checked, and if income includes the sale of farm equipment or = production=20 inputs and services to farmers, ranchers, foresters and farming=20 operations, please review the definition of Farm Income on Page = 2.

Signature

Read the=20 acknowledgments, responsibilities and authorizations, before affixing=20 signature.

For all types=20 of entities, the form must be signed by a duly authorized = representative=20 with an acceptable Power of Attorney or evidence of authority on = file with=20 FSA.

Title/Re-lationship

Enter the=20 title or relationship if signing in a representative capacity.=20

Date

Enter the=20 signature date in month, day and=20 year.

Read=20 General Information on Average Adjusted Gross Income, Page=20 2