Qualification For Farming Limited Liability Company Template 2012 Page 2

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6. Please check which applies to this Limited Liability Company:
This is a Family Farm
This is an Authorized Farm
7. Please complete the appropriate section:
The NUMBER OF MEMBERSHIP INTERESTS owned by person(s) who are
Family Farm
members of a family as defined in SDCL 47-9A-2, one of such shareholders being a
family member who is residing on the farm or actively operating the farm, or who has
_______________
resided on or has actively operated the farm. (See SDCL 47-9A-14)
The PERCENTAGE of gross receipts of the company derived from rent,
Authorized Farm
royalties, dividends, interest and annuities.
Note: Percentage amount cannot exceed 20% of its gross receipts.
______________%
8. The name, address and number of membership interests owned by each member
________________________________________________________________________________________________
Name
Address
City
State
Zip
Shares
________________________________________________________________________________________________
Name
Address
City
State
Zip
Shares
________________________________________________________________________________________________
Name
Address
City
State
Zip
Shares
________________________________________________________________________________________________
Name
Address
City
State
Zip
Shares
________________________________________________________________________________________________
Name
Address
City
State
Zip
Shares
________________________________________________________________________________________________
Name
Address
City
State
Zip
Shares
Dated ____________________________
______________________________________________
(Signature of an authorized officer)
______________________________________________
(Printed Name)
______________________________________________
(Title)
Llcfarmqualification 2012

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