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CRP-2(08-29-97) (Reber e) ; • , . , , . - .-‘,,i, '' 32. NAMES OF OTHER PRODUCERS ' • ID �....:. . 1/ iR_Irrigated I N1=Nonilrrlgated 2/ 1=initial Crop DC • Double Crop , SC=Subsequent Crop F=Failed Acreage PP=prevented Planted ■ APPF=Alter PP or F - A=Abandoned - la —- 3&crap nd Un Surrun q ' 33 34. 35 3G. 37. C II F F a Duct No. Field No. Crop or Lana Use d Crop suer A me 7 ' 199 6 ' 199 5 199 4 .1993 1/ 2/ Offered Acres i 1 , 1 � .3200 021 J a . o . s . • • • , 1 i . i ..^fit tic;. '-: 1 39. TOTALS 4 6 /. o ,, ,- n 40. APPLICANT'S CERTIFICATION: By signing below,I certify to all of the following: (1)To the best of my knowledge and belief the acreage of trop.t and land listed herein,if applicable, are true and correct; (2)All the Environmental benefits Index(EBI)factors and subfactors,except for the cost factor have been explained to me: (3)1 have been informed that planting an approved mixture of covers that benefit wildlife,enhancing the existing cover to provide d mixture that benefits wildlife,if applicable,offering leti than the calculated maximum payment rote,and/or declining cost-shale assistance May enhance acceptability of the offer; (4)I understand there is tto guarantee that the offer will be accepted; 15)I hove been infonoied that I may be required to pay for a measurement • service on the dcreagrl offered before such o`reage inay be enrolled In the CRP; (6)The signing of this form gives PSA representatives authorization to • enter and inspect crops and land USES on the above Identified land. I understand that an indccuiate etrtificdtion could result in a payment reduction or loss of program benefits. -- '_ . APPLI S SIG • t RE .DATE •2 ' . / h?/ .. • a/u e ( . "4 / 10- NOTE^. The following - . Is made h accordance •,C3'„. . Act of 1974(5 USC 552a)and the Paperwork Reduction Ad of 1996,as ornendeof The aullxwty f • requesting the fonou.ring tnfomatbn is the Fbod -• • . • of 1985.(Pub.L 99-19.as amended and regulation.*prornuk3cded at 7(2:RR Put 1410 and the Internal Revenue Code(26 L C 61091. The information requested is necessary for OCC to consider and process the offer to enter No a Conservation Reserve Program Contract. to assist In determining elicybdity.and to determine the carted parties to the contract R entshbl9 the requested isOrmation is voluntary. Failure to famish the requested Information will result in determination of iw igthey or certain program benefits and other f Inandai acssistance admtnlssteved by(WA agency. This b1anaatlan may be provided to other agencies.iRS.Department gfJustice.or other State and Federal Law eri6roen>ent agencies.and h response to a cote magistrate or adrrentsoadtie • brrmal The Footsies of vbninat and ct,tl fr iud statutes.kidtidbg 18 1SC 296.287.371.651,1001:15(SC 714rrm and 31 L SC 5728.May be applicable to the ' Infa»ndbn puArled Fbderol Agencies may not conduct or sponsor.and a person Is not required to respond to.a collection of Information tnless It displays a amently valid OMB contra number. Public reporting burden for this collection of Irtfomation Is estimated to average 5 minutes per response.Inc-hiding the tare f 6r reviewing Iuovctbres.searching misting data sauces.gad wring and mNrdalning the data needed and completing and reviewing the collection of information Send comments regarding this bvden esttrnate or any other aspect tY560-OI25?.Stop 7630.Wfashigton.collection DEC. 20250-7630. IE?VRgNsTESS suggestions IETF.D PCNRM to YOUR�CO[ MA offrM.MB