+-----------------------+--------------------+-------------------------+
| **USDA-NATURAL        | **COUNTY**         | **CONTRACT NO**.        |
| RESOURCES             |                    |                         |
| CONSERVATION          | **LANDOWNER**      | **NUMBER Of ACRES**     |
| SERVICE**             |                    |                         |
|                       |                    |                         |
| **Preliminary         |                    |                         |
| Certificate of        |                    |                         |
| Inspection and        |                    |                         |
| Possession**          |                    |                         |
+-----------------------+--------------------+-------------------------+
| Situated in           |                    | **DATE EXAMINED**       |
|                       |                    |                         |
| County, State of      |                    |                         |
+-----------------------+--------------------+-------------------------+

This is to certify that I,
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_,
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(Name of Examiner) (Official Title)

personally know the boundary lines and corners, and am acquainted with
the land designated above which is offered to the United States for
Wetlands Reserve Program (WRP) purposes. A plat or hand drawn map of the
approximate location of the easement area, and the access thereto, is
attached hereto marked exhibit A. I did on the above date, personally
enter upon and make a thorough examination of said land, and found the
following evidence of actual use or occupancy: (Here set forth the
nature and character of the use or occupancy found on said land, such as
houses, barns, sheds, fences, cultivation, orchards, fields, timber,
mining or other operations, utilities and roads. Also, if there is no
evidence whatsoever, PAST OR PRESENT, that the instant land has been
used or occupied, but is wild, virgin land\--simple state, "There is no
evidence whatsoever of either past or present actual use or occupancy of
the instant land.")

(use block 6 if additional space is needed)

I have asked the landowner if he owns all the above improvements
indicating use and occupancy. The landowner indicates he owns all of
such improvements except (List items indicating use or occupancy
[not]{.underline} owned by the landowner. Enter NONE if applicable.)

(use block 6 if additional space is needed)

If your careful and thorough investigation and inquiry disclosed any
occupancy or use of the instant land by any other person or persons,
corporation, or firm adversely (or in opposition) to the vendor or those
from whom title of the instant was obtained, give name and address (if
known or ascertained), and period of use occupancy.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

As to the forgoing use or occupancy, I hereby further certify that the
answers to the following questions are true to the best of my knowledge
and belief, upon careful and thorough investigation and inquiry.

1\. Does the vendor (owner) actually live on the tract, or a part of the
land out of which the instant tract is carved?

 Yes  No

If "yes", how long has the vendor actually lived on the instant land?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

2\. If not actually living on the land, is vendor using or occupying the
land by cultivation or otherwise?  Yes  No

If "yes", (a) In what manner and for what period?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\(b\) Has such use or occupancy been  Continuous  Intermittent

Contract Number\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3\. If the owner does not actually live on the instant tract, and is not
himself using the land by cultivation or otherwise\--is the land used or
occupied by tenant or license of the vendor? € Yes € No

If "yes", Is use or occupancy by tenant under lease or authority in
writing? Yes No

If "yes", (a) What is the term or period of lease or writing to tenant?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\(b\) If use or occupancy by tenant or licensee is by verbal
understanding, state terms and conditions.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\(c\) Give name and address of licensee, or tenant.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

4\. If instant tract not used or occupied by vendor, tenant or licensee,
is the land used or occupied by a stranger or a squatter,

persons wholly unconnected with vendor's title? Yes  No

\(a\) If "yes", give name and address of such user or occupant:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(b) By what claim or right does said stranger, or squatter, use or
    occupy said land\--by deed or other writing from one

> claiming title from a different source of title than that of the
> vendor, or merely as a trespasser without claim or right, title
>
> or interest?

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

\(c\) Has said use or occupancy been Continuous  Intermittent

5\. I have examined this parcel for hazardous materials and have found
the following indicators of the presence of hazardous materials. (If
there is no evidence of hazardous materials, such as isolated spots of
dead and dying vegetation, garbage and/or dump sites, unusual smells,
barrels containing unknown materials, etc., state NONE)

6\. Use this space as needed for continuation of above items.

  ------------------------------ ----------------------------------------
  I hereby further certify that  
  a careful investigation and    
  inquiry fails to disclose any  
  use or occupancy, past or      
  present, adversely, or in      
  opposition, to the above       
  vendor or those under whom he  
  claims or derived title,       
  except as noted.               

  Signed at \_\_\_(City and      
  State)\_\_\_\_\_ This          
  \_\_(Day)\_\_ of               
  \_\_\_(Month)\_\_\_,           
  \_\_(Year)\_\_                 

  EXAMINER (Name and Signature)  OFFICIAL TITLE
  ------------------------------ ----------------------------------------