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Kootenai County Farm Questionnaire AS-35

  1. 1. Select all that apply:
  2. Owner Operated
  3. Land in CRP/FSA
  4. Leased
  5. Crop Share
  7. 2. Fill in all applicable fields:
    If you produce more than one type of crop, list any additional crops with their associated Yield/ac, $/Ton, Lease Rent, etc... in the additional comments box at the end of this form.
  8. (i.e., Tons/Ac., Bu/Ac., #/Ac., etc...)
  9. (or $/Bu, $/#, etc...)
  10. ---- OR ----
  11. (i.e., 1/4 or 1/3 of the crop profits go to the landowner)
  12. (percent of the crop profit that the expenses take up)
  13. ---- OR ----
  14. (i.e., 1/4 or 1/3 of the crop's expenses are paid by the landowner)
  15. Is any of this land rented for winter grazing?
  16. No. Ac. Rented
  17. Annual Lease $
  18. 3. CPR or FSA
  19. Do you have any ground in CRP ?*

    (Conservation Reserve Program – NRCS)

  20. Contract Expiration Year
  21. Do you received any FSA paymetns?
    (Farm Service Agency)
  22. $/Year
  24. 4. Fill in all applicable fields: (One "Livestock Type" per Column)
    If you raise more than one type of livestock, list any additional kinds with their associated No. Head, No. Animals, Ac. Grazed, etc... in the additional comments box at the end of this form.
  25. (without supplemental feed)
  26. *AUM is the average amount of dry weight forage required by lactating 1000 lb. cow and her calf for one month (or about 912 lbs.).
  27. or $/Animal (indicate which)
  28. Do you lease your pasture ground?
  29. No. Ac. Rented
  30. $ Rent/Ac.
  31. Electronic Signature Agreement*
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  32. Leave This Blank:

  33. This field is not part of the form submission.