LS-48 Soybean Certification of Non-Producer Status

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

FORM APPROVED – OMB NO. 0581-0093

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
LIVESTOCK AND SEED PROGRAMS

SOYBEAN PROMOTION, RESEARCH, AND CONSUMER
INFORMATION PROGRAM (SPARC)
A program of promotion, research, and consumer information designed to strengthen, expand and develop
new foreign and domestic markets for soybeans and soybean products.

STATEMENT OF CERTIFICATION OF NON-PRODUCER STATUS
INSTRUCTIONS: Certificate must be filled out correctly and completely. When completed it must be given to the purchased or your soybeans
otherwise the purchaser is required under Federal Law to deduct 1/2% of 1%of the net market price from the final settlement.
Information on this form is required by 7 CFR 1220.241. Information is held confidential 7 CFR 1220.243.
PENALTIES: You may, by law, be fined up to $10,000, imprisoned up to five years or both for knowingly or willfully making false statements
within this document (18 U.S.C. Sec. 1001).
SELLERS STATEMENT
I claim non-producer status for

bushels of soybeans which I am selling this date:

, 20

.

SELLERS NAME
ADDRESS
CITY, STATE, ZIP
CERTIFICATION STATEMENT

I certify that I have purchased the soybeans to be sold in the transaction accompanying this certification and therefore do not owe an
assessment on such soybeans.
(CHECK APPROPRIATE BOX)
□ I collected 1/2% of 1% of the net market value when beans were
□ I received a Statement of Certification of Non-Producer status
purchased.
(Form No. LS-48) from the person from whom I purchased these
beans.
FEDERAL IDENTIFICATION NUMBER
SIGNATURE OF SELLER
POSITION/TITLE
DATE
Name and address of company or individual reporting this transaction on their SOYBEAN REPORT AND REMITTANCE FORM (Form No. LS46) (persons or entity to whom you are giving this certificate).
BUYERS NAME
ADDRESS
CITY, STATE, ZIP
The following statements are made in accordance with the Privacy Act of 1974 (U.S.C. 522a) and the Paperwork Reduction Act of 1995, as amended. The authority for requesting this information to be supplied on this
form is the Commodity Promotion, Research, and Information Act of 1996, Pub. L. 104-127, 110 Stat.1032 (7 U.S.C. 7411-7425). Furnishing the requested information is necessary for the administration of this program.
Submission of Tax Identification Number (TIN) or Employer Identification Number (EIN) is mandatory, and will be used to determine affiliation or entity identification.
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 0581-0093. The time required to complete this information collection is estimated to average 2 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, 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.

LS-48 (02-2011)