LS-83 Lamb Statement of Certification

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

FORM APPROVED - OMB NO. 0581-0093

Please mark an "X" in appropriate block:

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE

Producer
Seedstock Producer

STATEMENT OF CERTIFICATION

Feeder

(Lamb Promotion, Research, and Information Order)

First Handler
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. INFORMATION IS REQUIRED BY (7 CFR 1280.407)
Information is held confidential (7 CFR 1280.227). 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.

NAME AND ADDRESS OF ORGANIZATION OR ASSOCIATION

EFFECTIVE DATE

CERTIFICATION NUMBER

Name
Address
City

State

Zip Code

Upon due consideration of the organization's or association's application and of other available data, as
applicable, it is hereby determined that the organization or association indicated above is certified under the
Lamb Promotion, Research, and Information Order.
Accordingly, such organization or association is eligible to represent lamb producers, seedstock producers,
feeders, or first handlers, and to participate in the making of nominations of lamb producers, seedstock
producers, feeders, or first handlers to serve as members of the Lamb Promotion, Research, and Information
Board as provided for in the Order.

SIGNATURE OF DEPUTY ADMINISTRATOR, LIVESTOCK AND SEED PROGRAM

LS-83 (02-11) (Destroy previous editions.)

DATE