LPS-48 Soybean Certification of Non-Producer Status

FORM APPROVED. - OMB NO. 0581-0093

REPRODUCE LOCALLY. Include form number and date on all reproductions.
U.S. 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 purchaser of your soybeans,
otherwise the purchaser is required under Federal Law to deduct ½ percent of 1 percent 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 5 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
, 20

bushels of soybeans which I am selling this date:
.

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 ½ percent of 1 percent of the net market value when
beans were purchased.

I received a Statement of Certification of Non-Producer status
(Form No. LPS-48) from the person from whom I purchased
these beans.

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. LPS-46)
(persons or entity to whom you are giving this certificate).
BUYERS NAME
ADDRESS
CITY, STATE, ZIP

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 .03 hours 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.
LPS-48 (Rev. 04/17) (Destroy previous editions.)

See reverse for burden/non-discrimination statement

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