Address 3 Check the appropriate box indicating the entity type or enter the correct Entity Type entity type in if the entity type is not listed. “Other” 4 Enter the telephone number which best fits the entity, entity Entity representative, or authorized entity official for contact purposes. Contact Number 5 Enter the State where the entity is registered or incorporated. State of 6 Enter the entity’s registration number. Registration ID Number 7 Enter date entity was formally registered or formed. Date of Formation 8 Enter the tax identification number (9-digit number). entity’s Tax Identification Number 9 Enter the county in which the entity maintains its base of operations. County of Operation Headquarters 10 If the Operating Entity has 1 or more embedded entities within its Embedded and completed Items 11 13. Otherwise, composition, check “YES” – Entity check and proceed to completing Items 14-28B. “NO” Identifier 11 If the answer to Item 10 is enter the names of all embedded “YES”, List All entities comprised within the Operating Entity applicant. Embedded Entities 12 For the Operating Entity applicant, enter the percentage of interest the Percentage of Operating Entity holds in the farming operation. Interest For embedded entities within the Operating Entity, enter the percentage of interest each embedded entity holds. 13 Enter the number of individual Operating Entity members. Number of Entity For embedded entities within the Operating Entity, enter the number of Members individual entity members within each embedded entity.
Address 3 Entity Type Check the appropriate box indicating the entity type or enter the correct entity type in “Other” if the entity type is not listed. 4 Entity Contact Number Enter the telephone number which best fits the entity, entity representative, or authorized entity official for contact purposes. 5 State of Enter the State where the entity is registered or incorporated. 6 Registration ID Number Enter the entity’s registration number. 7 Date of Formation Enter date entity was formally registered or formed. 8 Tax Identification Number Enter the entity’s tax identification number (9-digit number). 9 County of Operation Headquarters Enter the county in which the entity maintains its base of operations. 10 Embedded Entity Identifier If the Operating Entity has 1 or more embedded entities within its composition, check “YES” and completed Items 11 – 13. Otherwise, check “NO” and proceed to completing Items 14-28B. 11 List All Embedded Entities If the answer to Item 10 is “YES”, enter the names of all embedded entities comprised within the Operating Entity applicant. 12 Percentage of Interest For the Operating Entity applicant, enter the percentage of interest the Operating Entity holds in the farming operation. For embedded entities within the Operating Entity, enter the percentage of interest each embedded entity holds. 13 Number of Entity Members Enter the number of individual Operating Entity members. For embedded entities within the Operating Entity, enter the number of individual entity members within each embedded entity.