Review
Review CCC-941 Average Adjusted Gross Income Certification
Check each answer below. When everything looks correct, continue to signature.
Required fields missing
Finish these items before signing:
- Confirm you read and agree to the CCC-941 consent.
Item 1 Return Completed Form To
Edit- Where should this CCC-941 be sent?
- Tift County FSA 1468 Carpenter Road South Tifton, GA 31793
Item 2 Name and Address
Edit- What name and address should match the tax return?
- Blue Sky Farms LLC 100 County Road Tifton, GA 31793
Item 3 Taxpayer Identification Number
Edit- Are you filing as an individual or a legal entity?
- Legal entity associated with a farm
Item 3 Taxpayer Identification Number
Edit- What is the Employer Identification Number?
- 12-3456789
Item 4 Program Year
Edit- What program year are benefits requested for?
- 2025
Item 5 Average Adjusted Gross Income
Edit- For that three-year period, was average AGI $900,000 or less?
- A. Less than or equal to $900,000
Part B Consent to Disclosure
Edit- Confirm you read and agree to the CCC-941 consent.
Item 7 Title/Relationship
Edit- What is your title or relationship to the legal entity?
- Managing Member
Item 6 Signature
Edit- What legal name will you use to sign?
- Casey Farmer
Item 8 Date
Edit- What date are you signing?
- 2026-05-31