LS-82 Application for Certification of Organization

REPRODUCE LOCALLY. Include form number and edition date on all reproductions.

FORM APPROVED - OMB NO. 0581-0198

Note: According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to
respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information
collection is 0581-0198. The time required to complete this information collection is estimated to average 30 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing
and reviewing the collection of information. The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and
activities on the basis of race, color, national origin, gender, religion, age, disability, sexual orientation, marital or family status, political
beliefs, parental status, or protected genetic information. (Not all prohibited bases apply to all programs.) Persons with disabilities who
require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA's TARGET
Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326W, Whitten Building, 14th and Independence Ave., SW, Washington, DC 20250-9410 or call (202) 720-5964 (voice and TDD). USDA is
an equal opportunity provider and employer.

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE

APPLICATION FOR CERTIFICATION
OF ORGANIZATION

NOTE: Information is collected in order to determine eligibility of organizations to nominate lamb producers, Please mark an "X" in appropriate block for which
seedstock producers, feeders and first handlers to serve as members of the Lamb Promotion, Research, and organization or association you are applying for
Information Board (Board). Application is voluntary and information is held confidential.
certification: (Mark only one box):
Organizations must apply for certification by the Secretary to be eligible to participate in the making of
Producer
nominations of lamb producers, seed stock producers, feeders and first handlers to serve as members of the
Board as provided in the Lamb Promotion, Research, and Information Order. Information submitted in
Seedstock Producer
response to all items must be complete. Please type or print clearly. Send original only to:
Feeder
Marketing Programs Branch
Livestock and Seed Program, AMS U.S. Department of Agriculture
First Handler
1400 Independence Avenue, SW, Stop 0251, Room 2628-S
Washington, DC 20250-0251
2. TELEPHONE

1. NAME AND ADDRESS OF ORGANIZATION (Include street address or P.O. Box No., City, State, ZIP)

3. TYPE OF ORGANIZATION
(State, Regional, National)

4. TOTAL ACTIVE MEMBERSHIP
(Most RECENT FULL calendar year)

In _______

Number __________

5. NUMBER OF ACTIVE MEMBERS ENGAGED IN 6. TOTAL ESTIMATED "PRODUCER" SALES OF
LAMB PRODUCTION FEEDING OR SLAUGHTER, FIRST HANDLER PURCHASE OF LAMB BY
ACTIVE MEMBERS
(Most RECENT FULL calendar year)
(Most RECENT FULL calendar year)
In _______

Number _________

As of Jan. 1, ______ Number ____________

7. AS EVIDENCE OF THE STABILITY AND PERMANENCY OF THE ORGANIZATION, GIVE:
A. Number of years in existence

B. Number of active members during each of the last four calendar years:
CALENDAR YEAR
NUMBER

C. Other evidence (Explain):

8. LIST THE SOURCE(S) FROM WHICH THE ORGANIZATION'S OPERATING FUNDS ARE DERIVED:

9. DESCRIBE THE FUNCTIONS OF THE ORGANIZATION:

10. DESCRIBE THE ORGANIZATION'S ABILITY AND WILLINGNESS TO FURTHER THE PURPOSE AND OBJECTIVES OF THE LAMB PROMOTION, RESEARCH, AND INFORMATION ORDER:

11. DESCRIBE THE GEOGRAPHIC TERRITORY COVERED BY THE ACTIVE MEMBERSHIP OF THE ORGANIZATION.:

12. DESCRIBE THE NATURE OR MAKE-UP OF YOUR ACTIVE MEMBERSHIP. INDICATE THE PROPORTION OF THE TOTAL NUMBER OF PRODUCERS, SEEDSTOCK
FIRST HANDLERS IN THE STATE OR GEOGRAPHIC AREA SERVED WHICH ARE ACTIVE MEMBERS OF THE ORGANIZATION:

PRODUCER, FEEDERS, AND

CERTIFICATION STATEMENT
I hereby certify that: (1) an interest of this organization is in the production or marketing of lamb or lamb products and (2) the information provided in response to the
above items is true, complete, and correct to the best of my knowledge. The Secretary of Agriculture may examine our books, documents, papers, records, files, and
facilities to verify any of the information submitted and may procure such other information as may be required to determine this organization's eligibility for
certification.
NAME AND TITLE OF PERSON COMPLETING THIS APPLICATION (Print or type) SIGNATURE

LS-82 (09-07)

(Destroy previous edition dated 07-03.)

DATE