LPS-78 Lamb Certification on Non-Producer Status (Seller)

FORM APPROVED - OMB NO. 0581-0093

REPRODUCE LOCALLY. Include form number and edition date on all reproductions.
UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE

CERTIFICATION OF NON-PRODUCER STATUS (FOR THE SELLER)
Failure to pay the lamb 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 5 years, or both, for knowingly or willfully making false statements within this document (18 U.S.C. §1001).
I CLAIM NON-PRODUCER STATUS ON
ON

(date)

(number)

HEAD OF LAMBS FOR A TOTAL LIVE WEIGHT OF

WHICH I AM RESELLING

BUYER'S NAME AND ADDRESS

I CERTIFY upon reselling these lambs in compliance with 7 CFR 1280.217 that I have purchased these lamb to facilitate the transfer of
ownership of these lambs to a third party and I am reselling these lambs no later than 10 days from the date I purchased them; or that I have
purchased these lambs and upon transfer shall receive only a sales commission or a service fee which was established prior to my purchase of
the lambs.
I (the reseller) further certify that when I purchased these lambs, collected the assessment due and passed it on to the subsequent
purchasers.
(Check applicable box(es))
1. I received a Certification of Non-Producer Status from the person I purchased these lambs from; or
2. I purchased these lambs in a transaction in which I was not responsible for paying an assessment.

Persons who owns these lambs at the time of sale and is claiming Non-Producer status.
RESELLER'S NAME:
SOCIAL SECURITY NO. OR TAX ID NO.:
ADDRESS:
CITY:
STATE/ZIP:
SIGNATURE OF RESELLER:
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 0581-0198. 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).
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and
employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex,
gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance
program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all
programs). Remedies and complaint filing deadlines vary by program or incident.

LPS-78 (Rev. 04/17)

See reverse for burden/non-discrimination statement

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign
Language, etc.) should contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the
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To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at
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information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail:
U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW., Washington, D.C. 20250-9410; (2) fax:
(202) 690-7442; or (3) email: [email protected]. USDA is an equal opportunity provider, employer, and lender.