MEMBER'S INFORMATION - US Department of Agriculture 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Part A. Enter the County, State, and Program Year at the top of the form. Then, for each member of the entity, fill in their name, complete Tax ID number (SSN or Employer ID), address, and percentage share of ownership.
3. Indicate whether each member has signature authority by selecting 'Yes' or 'No' in the corresponding field.
4. Proceed to Part B if any members are entities. List their names and repeat the information collection process as outlined in Part A.
5. Continue this process through Parts C and D for any additional embedded entities, ensuring all required fields are completed accurately.
6. If applicable, complete Part E for minor members or shareholders by providing their details and answering specific questions regarding their status.
7. Finally, sign and date Part F to certify that all information is accurate before submitting your completed form to your County FSA Office.

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