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<br />""....d -"'...... <br /><2,'.01\ PRACTICE APPROVAL <br /> <br />PAYME NT APPLlCATION <br /> <br />No further monies or other benefi ptJid out under this program unless this <br />NOTE' report is completed and filed as requIred by existing law and regulations (P.~. 93..86) <br />. Penalty for presenting fraudulent claim: Fine of not more than $10,000 or Impnson. <br />ment of not more than five vears. or both (18 V.S.C. 287). <br /> <br />FARM NO NAME AND ADDRESS <br /> <br />r. <br />P.A./J 148 <br /> <br />Phase Vlll <br />Leonard Li tzen.be,rj},er". ,Agt <br />& Robert Stroh (Leonard. .J. <br />16084 Ii C Rd 5 (535-42.5.3). <br />Plattevi11e, Co 80651 <br />C Rd19; Jolws.t.o.wn:',8pS.34 <br /> <br />roh ;19463 W <br /> <br />PHOt-;,E. N..O, . <br />Stroh <br />587-205.6 <br /> <br />"'w"',.""...... ,....."<;".." \J".:t <br /> <br />~".....--..--.. <br /> <br />__7_'.,,/, ~ <br /> <br /> <br />FIP <br /> <br />ECP <br />wapD <br />OTHER 0 <br /> <br />D <br />LTA D <br /> <br />ANA D <br />LTA D <br /> <br />Cost-shares Posted to ACP-259 <br /> <br />DATE APPROVED <br /> <br />DATE EARNED <br /> <br />1 <br />3 <br /> <br />-:/r- r? <br /> <br />2 <br /> <br />4 <br /> <br />~ . <br /> <br />6 <br /> <br />Your request for program cost-sharing to perform the practice shown below is approved for the farm identified above. If you decide not to per- <br />form this practice, or if you cannot complete:.it by the expiration date, please notify the issuing ASCS county office at once. <br /> <br />7. DESCRIPTION OF CONSERVATION AND/ <br /> <br /> <br />Special projec <br /> <br />EXPIRATION r\. <br />NOTICE 11 <br /> <br />NVI O\ENTAL PROBLEM <br /> <br />ak,e '& Farmers <br /> <br />NO. <br />_A <br /> <br />eMS <br /> <br />( ,/) <br /> <br />we <br /> <br />Irrigati <br /> <br />Concret <br /> <br />et/ c: <br /> <br />'7 <br />.3 ,tlt:/ <br /> <br />Pi e <br /> <br />300' <br /> <br />~-~ OF 7:" A8TUAI~ C0S7~; <br />.,....., ;", ;, '.U~ i\l~ TP ~,..o! 1 IH <br /> <br /> <br />., , <br /> <br />H. FOOTNOTE (If needed) <br /> <br />K <br />~ <br />DATE t,:. <br />r <br />. <br />t' <br />V. I (!.' JlI. <br /> <br />APPROVAL ISSUED FOR THETUNTY COMMITTEE <br /> <br />BY (j~. . e .L J/ <br /> <br /> <br />Instructions To Participant <br /> <br />To receive payment or credit for Bfl}'-COSt- ares earned on tMs practice, report per- <br />formaoce according to ITEM 9 abOve complete ITEMS 11 & 12 below; date and sign <br />the.-c-ertification below and file"';; issuing office by the reporting date in ITEM 8 above. <br /> <br />..l1. Did you bear all the expenses (except for :program cost-sharing) for performing this <br />practice? (If no, report name(s) and address{es} of other person(s) or agency who bore <br />any part of the expenses. Also show kind, extent and value of their contribution.) <br /> <br />YES 0 <br /> <br />NO 0 <br /> <br />Ai. Have you received, or will you receive a cost-share payment on this or any other farm <br />during the current fiscal year, Oct. I-Sept. 3D? (If yes, report name of State and county <br />fo, each such fann.) <br />YES 0 NO 0 <br /> <br />13. CERTIFICATION BY PARTICIPANT <br /> <br />I certify that the abave inforTnatWn is true and correct. 1 further certify that the entry in <br />CoL F shows tJw.t the practice was performed in accordance with the practice specifications <br />an? other program requirements. I hereby apply far payment for the extent determined by <br />)lie caunty committee as being performed. I agree to maintain this practice for at least <br />_years following the Yt!QT' the practice is compkted. <br /> <br />/ 01. <br /> <br />Sign rl. <br />Here" /" <br />..-/. <br /> <br />/ <br /> <br />PRODUCER'S COpy <br /> <br />$ <br /> <br />------ <br /> <br />Payment Sum'mary <br />14. Total CQlumn G $ <br />15. eMS or Payment $ <br />Deduction <br />16. Debt ~ignment $ <br />17. Net Payment S <br /> <br />18. Payment Approved (Initials) <br /> <br />19. Draft No. <br /> <br />20. SETOFF OR ASSIGNMENT <br />NAME AND ADDRESS <br /> <br /> <br />DRAFT NO.. <br /> <br />DRAFT NO <br />