No Form Number BEEF--Certificate of Organic Exemption (seller)

001001

CERTIFICATE OF ORGANIC EXEMPTION FOR THE SELLER

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 ORGANIC EXEMPTION ON____________ HEAD OF CATTLE WHICH I AM SELLING ON
(number)

TO:
(date)

BUYER’S NAME/ADDRESS:
I certify that I am a producer who operates under an approved National Organic Program (NOP) (7CFR part 205) system plan; producing only products that are
eligible to be labeled as 100 percent organic under the NOP and not a split operation. I also certify that the Cattlemen’s Beef Board has granted me an
exemption from paying the beef assessment in accordance with 7CFR part 1260.302. I understand that an original of this “Certificate of Organic Exemption”
must be provided to the purchaser (collecting person) at the time of sale to document that the $1 per head assessment is not due in this transaction or I will be
required to pay the assessment. Copies or Facsimiles WILL NOT be accepted.
Collection of your social security number is authorized by Executive Order 9397 and will be
used only for the purpose of positive identification. Furnishing this information is voluntary.
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 05810093. 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 USDA, Director, Office of Civil Rights, 1400
Independence Avenue, S.W., Washington, DC 20250-9410 or call (800) 795-3272 or (202)
720-6382 (TDD). USDA is an equal opportunity provider and employer.

Person who owns these cattle at the time of sale and is claiming
Organic Exemption from the Beef Checkoff Program assessment.
SELLER’S NAME:
SOCIAL SECURITY # or Tax ID #:
ADDRESS:
CITY:
STATE/ZIP:
SIGNATURE OF SELLER:

BUYER: Send this copy in with your monthly Remittance Report when required by your state beef council or the Cattlemen’s Beef Board (White)
BUYER’S COPY: Retain for your files (Yellow)
SELLER’S COPY: Retain for your files (Pink)