Organic Certifier Survey

United States Department of Agriculture

National Agricultural Statistics Service

Name

Address

City, State Zip

Date

Name:

We greatly appreciate your response and cooperation with the Organic Certifier Survey. As we discussed, your dominant position as an organic certifier in <state> requires us to obtain your permission in order to publish state estimates. Even though you have given this permission verbally, we would like for you to sign the following statement:

I agree to the release of certified organic number of operations and acreage/livestock inventory data in <state>. I understand that I may revoke this permission at any time.

Signed _______________________________________________________

Printed Name ­­­­­­­­­­­­­­­­­_________________________________________________

Title ________________________________________________________

We will not release your name with the estimates.

1400 Independence Ave., SW · Washington, DC 20250

(800) 727-9540 · (202) 690-2090 FAX · www.nass.usda.gov

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