How to Fill Out Form CCC-10

Form CCC-10 at a glance

What it is: CCC-10 is Representations for Commodity Credit Corporation or Farm Service Agency Loans and Authorization to File a Financing Statement and Related Documents.

Where and when to file: Return this completed form to your County FSA Office.

The undersigned is an applicant for a loan from the Commodity Credit Corporation (CCC) or the Farm Service Agency (FSA) or is currently indebted to CCC or FSA on account of loans previously made or will encumber, pledge or mortgage property to CCC or FSA to secure payment of a loan made or to be made by CCC or FSA.

A filled-in Form CCC-10 example: an individual applicant and spouse

Form CCC-10 example filled out, example: an individual applicant and spouse — Maria Sample, an FSA loan applicant, fills out Form CCC-10. Organization or Entity and Signature for Organization or Entity are left blank because she is an Individual. The picture shows her entries, and its names and figures are sample values. Her spouse Daniel Sample signs 10D, so Spouse's Full Legal Name holds his name. Nothing goes in Signature of Individual Title/Relationship because they sign for themselves, not in a representative capacity.

How to fill out Form CCC-10, box by box

Type of Undersigned

Part B, 1. Type of Undersigned: Individual or Organization or Entity.

Tax Identification Number

Part B, 2. Tax Identification Number (9 Digits).

Full Legal Name

Part B, 3. Undersigned's Full Legal Name. 4. Spouse's Full Legal Name.

State and County of Primary Residence

Part B, 5. State and County of Primary Residence if Undersigned is an Individual.

Organization or Entity

Part B, 6. If Undersigned is an Organization or Entity, Specify the Type of Organization or Entity.

Part B, 7. If undersigned's organization or entity is a registered organization or entity, specify the state in which the organization or entity was created.

Part B, 8. If undersigned's organization is a non -registered organization or entity, specify the state where the place of business is located or where the organization or entity conducts its affairs.

Signature of Individual

10A. Signature of Individual in Item 3 (By). 10B. Title/Relationship of the Individual Signing in the Representative Capacity.

10C. Date (MM/DD/YYYY).

10D. Signature of Individual in Item 4 (By).

10F. Date (MM/DD/YYYY).

Signature for Organization or Entity

11A. Signature for Organization or Entity in Item 3 (By).

11C. Date (MM/DD/YYYY).

11F. Date (MM/DD/YYYY).

More rules for Form CCC-10

For warehouse-stored CCC marketing assistance loans, a financing statement will not be filed but this form is necessary to establish the jurisdiction in which a lien search will be conducted.

The undersigned agrees to immediately notify CCC or FSA of any changes in this information.

In Part C, 9. The undersigned authorizes CCC or FSA to file a financing statement under the name of the undersigned for collateral to be described in the financing statement and security agreement at any time following the date that this instrument is signed.

I authorize CCC to enter on the financing statement a broader description of the collateral used to secure a CCC marketing assistance loan than the description on the applicable security agreement.

Common questions about Form CCC-10

Where do I file it?

Return this completed form to your County FSA Office.

What am I certifying when I sign?

By signing the form, I give CCC or FSA permission to file a financing statement prior to the execution of the security agreement, as well as to file amendments and continuations of the financing statement thereafter.

Sources

[1] Form CCC-10 (09-30-24), Representations for Commodity Credit Corporation or Farm Service Agency Loans and Authorization to File a Financing Statement and Related Documents, U.S. Department of Agriculture (the Official source link on this page).

Form CCC-10 PDF Details