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Get 49 Application 2019-2024

USDA is an equal opportunity provider and employer. CCC-49 11-28-11 Page 2 Are All Warehouse Units Owned 16A. This form is available electronically. U.S. DEPARTMENT OF AGRICULTURE CCC-49 Commodity Credit Corporation See Page 2 for Privacy Act and Paperwork Reduction Act Statements. LEAVE BLANK CCC USE ONLY 1. Warehouse Code No* 11-28-11 2. Master Code No* APPLICATION FOR APPROVAL OF WAREHOUSE FOR COTTON STORAGE AGREEMENT CSA 4. Mailing Address of Warehouse Including Zip Code 3. Name and Location of Warehouse Exactly as Printed and/or Shown on Warehouse Receipts 5. County in Which Warehouse is Located 6. Name of Warehouse Operator Individual s or entity name 7A. Name of Manager or Superintendent of Warehouse 8. Warehouse Telephone Number Including Area Code 9. Warehouse Fax Number 7B. E-Mail Address 10. IS/DOES WAREHOUSE YES NO 11. WAREHOUSE IS OPERATED BY A. Licensed under United States Warehouse Act Individual B. Licensed by the State Partnership C. Operate gin and/or compress facilities Corporation or Cooperative D. Storage Capacity Licensed CHECK Limited Liability Company LLC Other Specify E* 12. If warehouse is operated by a corporation or cooperative association give the names of all officers. If a corporation also give the names of all principal stockholders. Officers Shares Held Other A. President Member or Individual F* Principal Stockholder s B. Vice-President or Member C. Secretary or Member D. Treasurer or Member E* General Manager Member or Like Officer 13. If a Partnership give Names of Partners 14. Is it a Limited Partnership If YES attach statement signed by all partners explaining limitations. 15. Warehouse Operator Identification of Each Warehouse Unit its Location and Capacity Attach schedule if necessary s A. Unit Identity B. Street Address and City if Different Than Item 3 C. Capacity Bales D. TOTAL The U*S* Department of Agriculture USDA prohibits discrimination in all of its programs and activities on the basis of race color national origin age disability and where applicable sex marital status familial status parental status religion sexual orientation political beliefs genetic information reprisal or because all or part of an individual income is derived from any public assistance program* Not all prohibited bases apply to all programs. Persons with disabilities who require alternative means for communication of program information Braille large print audiotape etc* should contact USDA TARGET Center at 202 720-2600 voice and TDD. To file a complaint of discrimination write to USDA Assistant Secretary for Civil Rights Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue S*W* Stop 9410 Washington DC 20250-9410 or call toll-free at 866 632-9992 English or 800 877-8339 TDD or 866 377-8642 English Federal-relay or 800 845-6136 Spanish Federal-relay. 16C. 16B. If Any Units are Leased Give Attach schedule if necessary. Date MM-DD-YYYY Lease Expires Name of Lessor Has Warehouse Operator a Renewal Option on Leased Unit s Is Any Section or Unit of Warehouse Located on Railroad Siding Serviceable for Placement of Cars If complete Item 18.

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