Form 1 "Application to Produce Certified Cotton" - Arkansas

What Is Form 1?

This is a legal form that was released by the Arkansas Agriculture Department - a government authority operating within Arkansas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2002;
  • The latest edition provided by the Arkansas Agriculture Department;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form 1 by clicking the link below or browse more documents and templates provided by the Arkansas Agriculture Department.

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Download Form 1 "Application to Produce Certified Cotton" - Arkansas

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ARKANSAS STATE PLANT BOARD
FORM 1
APPLICATION TO PRODUCE CERTIFIED COTTON
(REV. 5/02)
NAME
PHONE(
)
FAX (
)
ADDRESS
ZIP
1) ________________________________ VARIETY (USE A SEPARATE APPLICATION FORM FOR EACH VARIETY)
I PLANTED
ACRES OF BREEDER SEED TO PRODUCE FOUNDATION GRADE SEED.
I PLANTED
ACRES OF FOUNDATION SEED TO PRODUCE REGISTERED GRADE SEED.
I PLANTED
ACRES OF REGISTERED SEED TO PRODUCE BL UE TAG GRADE SEED.
2) SEED SOURCE
(SUBMIT AS PROOF, A CERTIFIED LABEL FROM EACH LOT AND COPIES OF INVOICES AND/OR STATEMENTS
SHOWING THE AMOUNT OF SEED AND ALL LOT NUMBERS)
SEEDSMAN'S N AM E ON LABE L
LOT #
BU. PLANTED
LOT #
BU. PLANTED
LOT #
BU. PLANTED
LOT #
BU. PLANTED
3) FARM DIRECTIONS AND GIN INFORMATION: (USE BACK OF THIS FORM IF THERE IS MORE THAN ONE FIELD OR GIN)
NAM E AN D LO CAT IO N OF GIN :
IS THIS A CUSTOM GIN? ______ IF NOT A CU ST OM GIN, W ILL IT GIN ONLY TH E C OTT ON T O BE CERT IFIED?_______
MY FARM IS
MILES (C IRCLE O NE ) N S E W FROM
ON HIGHWAY
NAME OF FARM MANAGER
PHONE
PLEASE ENCLOSE A DETAILED MAP WITH LANDMARKS AND SHOWING THE LOCATION OF EACH FIELD. A GOOD MAP WILL
ALLOW THE INSPECTOR TO FIND THE RIGHT FIELDS. EVEN IF YOU PLAN TO HAVE SOMEONE AVAILABLE TO SHOW THE
INSPECTOR THE FIELDS, PLEASE ENCLOSE A MAP.
(YOUR AREA FIELD INSPECTOR'S NAME
)
4) (
YES , I DO) (
NO, I DON'T) WANT MY CERTIFIED ACREAGE TO BE SHOWN IN THE SEED DIRECTORY.
5) A SEED DEALER'S LICENSE OR CERTIFICATION PERMIT IS REQUIRED:
S E E D DE AL E R 'S L IC E N S E A PP L IC A TIO N :
ENCLOSED
ON FILE
C E R T IF IC A TIO N P E R M IT AP P LIC A TIO N :
ENCLOSED
ON FILE
6) FEES ENCLOSED:
$ 20.00
VARIETAL FEE
$
PROM OTIONAL FEE ($0.10 PER ACRE)
$
ACREAGE ($1.50 PER ACRE)
$
LATE FEE
ADD $50.00 IF FILED AFTER DEADLINE (JULY 1)
$
TOTAL ENCLO SED
I HEREBY CERTIFY THAT THE INFORMATION GIVEN HEREIN IS TRUE AND CORRECT AND THAT THE PLANTING, HARVESTING,
AND CONDITIONING EQUIPMENT WILL BE CLEANED AND THE IDENTITY OF THE SEED WILL BE MAINTAINED FROM THE TIME OF
HARVEST UNTIL IT LEAVES MY POSSESSION.
SIGNED
DATE
STATE PLANT BOARD, PO BOX 1069, LITTLE ROCK, AR 72203 Phone (501) 225-1598 / Fax (501) 225-7213
ARKANSAS STATE PLANT BOARD
FORM 1
APPLICATION TO PRODUCE CERTIFIED COTTON
(REV. 5/02)
NAME
PHONE(
)
FAX (
)
ADDRESS
ZIP
1) ________________________________ VARIETY (USE A SEPARATE APPLICATION FORM FOR EACH VARIETY)
I PLANTED
ACRES OF BREEDER SEED TO PRODUCE FOUNDATION GRADE SEED.
I PLANTED
ACRES OF FOUNDATION SEED TO PRODUCE REGISTERED GRADE SEED.
I PLANTED
ACRES OF REGISTERED SEED TO PRODUCE BL UE TAG GRADE SEED.
2) SEED SOURCE
(SUBMIT AS PROOF, A CERTIFIED LABEL FROM EACH LOT AND COPIES OF INVOICES AND/OR STATEMENTS
SHOWING THE AMOUNT OF SEED AND ALL LOT NUMBERS)
SEEDSMAN'S N AM E ON LABE L
LOT #
BU. PLANTED
LOT #
BU. PLANTED
LOT #
BU. PLANTED
LOT #
BU. PLANTED
3) FARM DIRECTIONS AND GIN INFORMATION: (USE BACK OF THIS FORM IF THERE IS MORE THAN ONE FIELD OR GIN)
NAM E AN D LO CAT IO N OF GIN :
IS THIS A CUSTOM GIN? ______ IF NOT A CU ST OM GIN, W ILL IT GIN ONLY TH E C OTT ON T O BE CERT IFIED?_______
MY FARM IS
MILES (C IRCLE O NE ) N S E W FROM
ON HIGHWAY
NAME OF FARM MANAGER
PHONE
PLEASE ENCLOSE A DETAILED MAP WITH LANDMARKS AND SHOWING THE LOCATION OF EACH FIELD. A GOOD MAP WILL
ALLOW THE INSPECTOR TO FIND THE RIGHT FIELDS. EVEN IF YOU PLAN TO HAVE SOMEONE AVAILABLE TO SHOW THE
INSPECTOR THE FIELDS, PLEASE ENCLOSE A MAP.
(YOUR AREA FIELD INSPECTOR'S NAME
)
4) (
YES , I DO) (
NO, I DON'T) WANT MY CERTIFIED ACREAGE TO BE SHOWN IN THE SEED DIRECTORY.
5) A SEED DEALER'S LICENSE OR CERTIFICATION PERMIT IS REQUIRED:
S E E D DE AL E R 'S L IC E N S E A PP L IC A TIO N :
ENCLOSED
ON FILE
C E R T IF IC A TIO N P E R M IT AP P LIC A TIO N :
ENCLOSED
ON FILE
6) FEES ENCLOSED:
$ 20.00
VARIETAL FEE
$
PROM OTIONAL FEE ($0.10 PER ACRE)
$
ACREAGE ($1.50 PER ACRE)
$
LATE FEE
ADD $50.00 IF FILED AFTER DEADLINE (JULY 1)
$
TOTAL ENCLO SED
I HEREBY CERTIFY THAT THE INFORMATION GIVEN HEREIN IS TRUE AND CORRECT AND THAT THE PLANTING, HARVESTING,
AND CONDITIONING EQUIPMENT WILL BE CLEANED AND THE IDENTITY OF THE SEED WILL BE MAINTAINED FROM THE TIME OF
HARVEST UNTIL IT LEAVES MY POSSESSION.
SIGNED
DATE
STATE PLANT BOARD, PO BOX 1069, LITTLE ROCK, AR 72203 Phone (501) 225-1598 / Fax (501) 225-7213
SEND AS PRO OF, CERTIFIED LABELS FRO M EACH LOT PLAN TED AND INVOICES AND/OR STATEMENTS W ITH LOT NUMBERS.
LOCATION
NO. ACRES
FIELD
GRADE
LOT
BUSHELS
NAME OF SEEDSMAN ON
PLANTED
NUMBER
USED
GROWER
PLANTED
NUMBER
THE LABEL
(Show on Map)
TOTALS
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