Beef-Certification of Non-Producer Status (reseller)

SAMPLE ONLY

OMB 0581-0093

1231231

CERTIFICATION OF NON-PRODUCER STATUS (FOR THE RESELLER)

Failure to pay the beef checkoff is a violation of federal law. This form must be properly completed and signed to be valid. 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. p 1001).

I CLAIM NON-PRODUCER STATUS ON ______________ HEAD OF CATTLE WHICH I AM RESELLING ON ___________________________ TO:
(number)

(date)

BUYER’S NAME/ADDRESS: _______________________________________________________________________________________________
I certify upon reselling these cattle in compliance with 7CFR 1260.314 that I have purchased these cattle to
facilitate the transfer of ownership of these cattle to a third party and I am reselling these cattle no later than
10 days from the date I purchased them; or that I have purchased these cattle and upon transfer shall
receive only sales commission or a service fee which was established prior to my purchase of the cattle.

Person who owns these cattle at the time of
sale and is claiming Non-Producer status.

I (the reseller) further certify that I purchased these cattle on _______________ and:
(date(s))
(Check only one box)
1.
2.
3.

RESELLER’S NAME:

I collected $1.00 per head; or
I received a Certification of Non-Producer Status from the person I purchased these cattle from: or
I purchased these cattle in a transaction in which I was not responsible for collecting the $1 per head
(Auction Market or Brand Inspector).

Tax ID #:
ADDRESS:

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).

CITY:
STATE/ZIP:
SIGNATURE OF RESELLER:

To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW,
Washington, DC 20250-9410 or call (800) 795-3272 or (202) 720-6382 (TDD). USDA is an equal employment opportunity
provider and employer.
BUYER:

Send this copy in with your monthly Remittance Report when required by your state beef council or the Cattlemen’s Beef Board