Form 7-2180 - Certification Of Individual'S Landholdings - 2016

Download a blank fillable Form 7-2180 - Certification Of Individual'S Landholdings - 2016 in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form 7-2180 - Certification Of Individual'S Landholdings - 2016 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

Clear Form

Instructions Link

OMB CONTROL NO.: 1006-0005

FORM 7-2180

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

CERTIFICATION OF INDIVIDUAL’S LANDHOLDINGS

District Name:

2016

(Discretionary Provisions)

(7-15)

DATE RECEIVED:

BUREAU OF RECLAMATION

Do not use this form after December 31, 2016. 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.

LANDHOLDER INFORMATION

Landholder name:

Marital status:

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:

List all entities in which you, your spouse, if you are married, and/or your dependents hold irrigable and/or irrigation land. Include only those entities that directly own or lease land in

which you, your spouse, and/or your dependents own 100-percent interest. List the names of your dependents if they hold land in their own names or other names in which you or your

spouse hold land. Do not list trusts and estates of which you are a beneficiary. Instead, list such trusts and estates in item 15. For purposes of determining total landholdings, land

listed here must be listed again in the appropriate section of this form. All trusts and estates must complete Form 7-21TRUST. For additional space, use attachments.

(c)

(d)

(f) Status

(b)

(e)

(a)

State(s) or Country(ies)

Legal Description of Land Parcel(s) or

Employer Identification Number

Number of Acres

Name

(where established,