§516.01 Form AD-1026 (02-01-91). 



AD.1026 •"«'•" UMTEO STATES OEPAirnkKNT OF ACmCULTURC '* 



HIGHLY ERODIBLE LAND CONSERVATION (HELC) AND WETLAND 

 CONSERVATION (WC) CERTIFICATION 



1. Name of Producar 



2. klemitication NumMr 



3. Crop Year 



4. Do ihe anached AD-I026A(s) lisi all your farming imerests by county, and show current 

 SCS deicrminaiions? // "No", conwit vour County ASCS Office hrfnrt complriini! this form 



Are you now applying for, or do you have a FmHA insured or guaranteed loan? 



6. Do you have a crop insurance contract issued or reinsured by the Federal Crop 

 Insurance Corporation? 



7. Are you a landlord on any fann listed on AD-1026A thai will noi be in compliance with 

 HELC and WC provisions? 



8. Has a HELC exemption been approved on any farms listed on AD-1026A because ihe 

 landlord refuses to comply? 



9. List here or attach a list of affiliated persons with farming interesu. Set revtne for on 

 explanation. Enter "\one", if applicable. 



YES NO 



H Items 7 Of 8 are answered "YES", arcie tn« appiicatM farm nomoer on AD-1026A. 



During atther the crop y«ar •niarcd In Item 3 abov*. or the tann of a raquattad USOA loan: 



10. Will you plant or produce an acncultural commodity on land for which a highly erodible 

 land determination has not been made? 



1 1. W ill you plant or produce an agricultural commodity on any land that is or was a wet area 

 on which planting was made possible by draining, dredging, filling, or leveling or anv other 

 means after December 23. 1985? 



11 Will you. or have you since November 28. 1 990. made possible the planting of any crop, 

 pasture, agricultural commodity, or other such crop by: (a) convening anv wet areas by 

 draining, dredging, filling, leveling, or any other means, or. (b) improving or modifying a 

 drainage system? 



13. Will you convert any wet areas for fish production, trees, vineyards, shrubs, building 

 construction, or other non-agncultural use? 



YES 



MO 



H answer* to Items 10, 11, 

 12, or 13 are: 



}: 



"YES" tor any on* o» thes* items, sign and date in item 14 below. CtrOa the applicable 

 traa numoof on AO-1026A. or list m item 12 on AD-1026A. ASCS w« reter mis AD-1026 

 SCS (or a determination. DO NOT sign m nem 16 tmtri SCS detemwution « compteie. 



"NO" for all o( these items or SCS detemwwions are comoi«l«. complete item 16. 



,- -,___^ , I '>»''** '•""r !*>•"»<• •^'o'l -t omat tan. anttlmmtontmtioncinmci-aAD-liatAt. f nv aM cofma to m» ttm o4 my 



i«. Signaturaet k n en H td g i and bttm. 



Producar < 

 15.Re«an«IToSCS 



Jq 



Ei«ereV<«SCSo»»fm««»on«n.«jedd«au»«r-| °""**^ js*>»«. oi ascs »«»•««»« 



ats_ 



(CemplM»^ by JkSCSf 'Ves-aannMraaniMniia il. is.erta. 



n 



NOTE: Bafora signing In Ham 16. Read AD-1026 Append<«. 



16. Signature of 

 Producer^ 



lhft>ye»ftifrlf>ttn»abe<fmlormatien.andlt»mtormm i oi>enut»eii»dAO-1016At. M rrue and comet W m* M*t o> my 

 AD-ltat AppmtdiM. 



17. Remarks: 



Jcais. 



OMoatM. ■ ASCS coar 



516-1 



(180-V-NFSAM, Second Ed., Amend 6, May 1991) 



