LP-8 Beef--App. for Use of Non-Producer Certification Stamp A

Beef Checkoff Program OMB No. 0581-0093

APPLICATION FOR USE OF A STAMP TO CERTIFY NON-PRODUCER STATUS

I. APPLICANT INFORMATION

A. Identification of Applicant B. Type of Business Applicant

Name _______________________________________________ will use stamp as:

Company _____________________________________________ ___ Order Buyer

Address ______________________________________________ ___ Dealer/Trader

City, State, Zip _______________________________________________________ ____ Market

Physical Location ______________________________________ ___ Feedlot

Federal Tax ID/SS No. ___________________________________ ___ Other (explain)

Phone No. _____________________________________________

Email _________________________________________________

OFFICE USE ONLY STAMP NO. ASSIGNED

__________________

__________________

__________________

C. Other Names

Applicant also conducts business under the following names

(Name, entity relation to applicant, type of business) _________________________________________________

II. CONDITIONS

A. In making this application for a stamp to certify non-producer status, Applicant certifies that during any one month of the preceding 12-month period, Applicant has resold cattle in at least 20 individual transactions and agrees to the following conditions for use:

1. Applicant will be permitted by the Cattlemen’s Beef Promotion and Research Board to use this stamp to certify non- producer status for cattle which the Applicant sells in lieu of providing a certification of non-producer form to the buyer or person paying Applicant in such sales transactions.

2. Applicant will use this stamp only on a document which provides the following information:

a. Seller’s name;

b. Buyer’s (or market agency’s) name;

c. Number of cattle sold; and

d. Date of transaction.

3. Applicant certifies that the name under which it has submitted this Application (Section 1, Paragraph A. above) is the only name in which it will conduct business in connection with the use of this stamp to certify non-producer status.

4. Applicant certifies that prior to using this stamp in any transaction, all conditions for claiming non-producer status with regard to cattle sold in the transaction shall be met, those conditions are:

a. Applicant has collected $1.00 per head on cattle upon the purchase of the cattle; or

b. Applicant has received a certification of non-producer status form from the seller of the cattle when

Applicant purchased them; or

c. Applicant purchased the cattle in a transaction in which the Applicant was not responsible for collecting

$1.00-per-head assessment (collected by brand inspector or by the market); and

d. Applicant acknowledges that upon selling these cattle in any transaction that uses the stamp, the Applicant is certifying that the Applicant has purchased these cattle to facilitate the transfer of ownership of these cattle to a third-party and (1) the Applicant is reselling these cattle no later than 10 days from the date the Applicant purchased them; or (2) that upon transfer of these cattle the Applicant shall receive only a sales commission or a service fee that was established prior to Applicant’s purchase of the cattle.

B. Applicant acknowledges and understands that should Applicant use the stamp to certify non-producer status on any document in which the Applicant knowingly or willfully make false statements, that Applicant may be fined up to $10,000, imprisoned up to 5 years, or both for the action pursuant to 18 U.S.C. §1001.

C. Applicant certifies that it will not allow any other person or business entity to utilize this stamp in any transaction in which the Applicant is not the seller of the cattle, and that only those authorized to do so by the Applicant shall certify non-producer status on a sales document.

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D. Applicant certifies that only the following signature is authorized for use in connection with this stamp to certify non- producer status.

Signature Print or Type Name

E. Applicant understands and acknowledges that the Cattlemen’s Beef Promotion and Research Board may revoke the right to utilize the stamp at any time upon notification to Applicant of the revocation.

F. Applicant certifies that Applicant fully understands the conditions for claiming non-producer status, and that any and all documents relating to transactions in which Applicant has sold cattle which contain this stamp fully meet the conditions for non- producer status, and that all such documents or copies thereof be maintained for at least 3 years by the Applicant.

Signature of Applicant

Position

_Date

Notary Seal

_{Subscribed and sworn to before me this day of , 20____.}

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The following statements are made in accordance with the Privacy Act of 1974 (5 U.S.C. §522a) and the Paperwork Reduction Act of 1995, as amended. The authority for requesting this information to be supplied on this form is the Commodity Promotion, Research, and Information Act of 1996, Pub. L. 104-127, 110 Stat.1032 (7 U.S.C. §7411-7425). Furnishing the requested information is necessary for the administration of this program. Submission of Tax Identification Number (TIN) or Employer Identification Number (EIN) is mandatory, and will be used to determine affiliation or entity identification.

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 20 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.

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.

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 Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at

http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the 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.

SAMPLE of the Non-Producer Stamp:

CERTIFICATION OF NON‐PRODUCER STATUS FOR THE RESELLER – CO #04

Claimed on # cattle pursuant to

7 CFR 1260.116 and 1260.314

DO NOT DEDUCT the

$1.00 per head Beef Promotion Assessment Cattlemen’s Beef Promotion & Research Board

/

Signature Date

LP-30 (Expiration Date 08/31/2023)

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