Form 7-2190ez - Ez Report Of Individuals Landholdings - 2016

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OMB CONTROL NO.: 1006-0005

FORM 7-2190EZ

Districts must complete the “District Name” and “Date Received” boxes.

“EZ” REPORT OF INDIVIDUAL’S LANDHOLDINGS

District Name:

2018

(Prior Law Provisions)

DATE RECEIVED:

(7-17)

BUREAU OF RECLAMATION

Do not use this form after December 31, 2018. It is important that you read the separate instructions that accompany this form before completing it. If you did not receive these instructions,

please contact your district office. Type or print in ink. Date and initial crossouts and corrections. Visit

for more information.

You may use this form ONLY IF: (1) All your landholdings subject to acreage limitation provisions are located in only one district, (2) your landholdings subject to acreage limitation provisions total 160 acres or less (320 acres for a married

couple, if each spouse holds an equal interest), (3) you directly hold all your landholdings (that is, the land is not owned or leased through any type of legal entity, such as a corporation, trust, estate, or partnership, or in the names of your children

or other dependents), (4) you are not a dependent, AND (5) you are subject to the prior law provisions. If you do not meet all of these requirements, do not complete this form. Please contact your district office to obtain the proper form.

Landholder name:

2(b). If you responded “widowed” to item 2(a), as the surviving spouse were you left with more than

□

YES

160 acres of land that is eligible to receive Reclamation irrigation water until it is sold?

2(a). Marital status:

2(c). Number of acres held prior to death of spouse:

Spouse name:

4(a). Landholder’s street address or rural route number, city, state, and ZIP code:

4(b). Mailing address if different from street address:

5(a). Telephone number where questions can be directed: (

)

5(b). Contact person:

Check the box that indicates your citizenship status. If you are a

Self

Spouse

Country of Citizenship

U.S. Citizen

nonresident alien, also enter the country of which you are a citizen.

Resident Alien

Nonresident Alien

LAND YOU OWN

List all irrigable and/or irrigation land parcels that are 100-percent owned by you. Include land you lease from a public entity here. Identify such land as leased from a public entity and

include the name of that public entity after the legal description of the land. You are completing the wrong form if you own land (but not 100-percent interest), or own any land through an

entity. The proper form(s) can be obtained from your district office. For additional space, use Form 7-21CONT-O or your own similar continuation sheet.

(b) Operated by:

Lease Information

(a)

(check one)

(c)

(f)

Legal Description of Land Parcel(s) or Assessor’s Parcel Number

Identification of Lessee, Sublessee, or

Number

(d)

(e)

(There is space to list four different parcels [one parcel per line]