No Form number Oregon/California Seed Potatoes Certificate of Privilege

OMB No. 0581-0178

OREGON-CALIFORNIA POTATO COMMITTEE

9320 SW BARBUR BLVD., SUITE 130

PORTLAND, OREGON 97219-5405

Phone: (503) 731-3300 / Fax: (503) 239-4763

HANDLERS APPLICATION FOR CERTIFICATE OF PRIVILEGE

FOR SHIPMENT OF CERTIFIED SEED

Application is herby made for the issuance of a Certificate of Privilege for the 20___ - 20___ marketing year to permit me to make shipments of certified seed as specified in Handling Regulation § 947.340 of Marketing Order No. 947.

In consideration of the Oregon-California Potato Committee (Committee) granting this Certificate, I agree to the following:

1. That I will report to the Committee all shipments of certified seed outside the district where grown.

I certify to the Committee and the Secretary of Agriculture that any shipments made pursuant to this Certificate of Privilege will be made in accordance with the Committee regulations.

Handler (Please Print)		Authorized Representative’s Signature
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Rev. 10/2010. Destroy previous editions.