ST-470-E Exhibit E Statement of the Basis of Ownership

REPRODUCE LOCALLY. Include form number and edition date on all reproductions. FORM APPROVED - OMB No. 0581-0055

U.S. DEPARTMENT OF AGRICULTURE AGRICULTURAL MARKETING SERVICE EXHIBIT E STATEMENT OF THE BASIS OF OWNERSHIP	Application is required in order to determine if a plant variety protection certificate is to be issued (7 U.S.C. 2421). The information is held confidential until the certificate is issued (7 U.S.C. 2426).
1. NAME OF APPLICANT(S)	2. TEMPORARY DESIGNATION OR EXPERIMENTAL NUMBER	3. VARIETY NAME
4. ADDRESS (Street and No., or R.F.D. No., City, State, and ZIP, and Country)	5. TELEPHONE (Include area code)	6. FAX (Include area code)
	7. PVPO NUMBER
8. Does the applicant own all rights to the variety? Mark an "X" in the appropriate block. If no, please explain. YES NO
9. Is the applicant (individual or company) a U.S. national or a U.S. based company? If no, give name of country. YES NO
10. Is the applicant the original owner? YES NO If no, please answer one of the following: a. If the original rights to variety were owned by individual(s), is (are) the original owner(s) a U.S. National(s)? YES NO If no, give name of country b. If the original rights to variety were owned by a company(ies), is (are) the original owner(s) a U.S. based company? YES NO If no, give name of country
11. Additional explanation on ownership (Trace ownership from original breeder to current owner. Use the reverse for extra space if needed):
PLEASE NOTE: Plant variety protection can only be afforded to the owners (not licensees) who meet the following criteria: 1. If the rights to the variety are owned by the original breeder, that person must be a U.S. national, national of a UPOV member country, or national of a country which affords similar protection to nationals of the U.S. for the same genus and species. 2. If the rights to the variety are owned by the company which employed the original breeder(s), the company must be U.S. based, owned by nationals of a UPOV member country, or owned by nationals of a country which affords similar protection to nationals of the U.S. for the same genus and species. 3. If the applicant is an owner who is not the original owner, both the original owner and the applicant must meet one of the above criteria. The original breeder/owner may be the individual or company who directed the final breeding. See Section 41(a)(2) of the Plant Variety Protection Act for definitions.
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 0581-0055. The time required to complete this information collection is estimated to average 0.1 hour per response, including the time for reviewing the 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, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program (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 to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

ST-470E (02-06) designed by the Plant Variety Protection Office using Word 2003