Form 15 "Application to Produce Certified Seed" - Arkansas

What Is Form 15?

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, 2014;
  • 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 15 by clicking the link below or browse more documents and templates provided by the Arkansas Agriculture Department.

ADVERTISEMENT
ADVERTISEMENT

Download Form 15 "Application to Produce Certified Seed" - Arkansas

Download PDF

Fill PDF online

Rate (4.4 / 5) 74 votes
ARKANSAS STATE PLANT BOARD
FORM 15
APPLICATION TO PRODUCE CERTIFIED SEED
(REV. 5/2014)
(COMPLETE ALL BLANKS)
NAME
PHONE(
)
FAX(
)
ADDRESS
UPS ADDRESS
EMAIL ADDRESS
1)
VARIETY & KIND
(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 BLUE TAG GRADE SEED.
2) LAND HISTORY (
) CHECK CIRCULAR 15 FOR LAND REQUIREMENTS.
USE THE BACK OF THE FORM TO LIST LAND HISTORY
COMPLETE FOR RICE - LAST 2 SUMMER CROPS
COMPLETE FOR SMALL GRAINS - LAST 2 WINTER CROPS
(EXCEPTION: IF LAND IS WINTER FALLOWED - SHOW LAST 2 SUMMER CROPS)
COMPLETE FOR SOYBEANS - PREVIOUS CROP GROWN
(EXCEPTION: IF THE PREVIOUS CROP WAS SOYBEANS, THE VARIETY MUST HAVE
BEEN PLANTED WITH CERTIFIED SEED OF THE SAME VARIETY OR ANOTHER VARIETY
WITH A DIFFERENT HILUM COLOR OR PUBESCENCE COLOR)
3) SEED SOURCE
PURCHASED SEED: SUBMIT A CERTIFIED LABEL FROM EACH LOT, COPY OF INVOICES SHOWING WHERE
SEED WAS ORIGINALLY PURCHASED, HOW MUCH SEED WAS PURCHASED, AND LOT NUMBERS.
OWN PRODUCTION SEED: ATTACH A COPY OF SEED LAB COMPLETE ANALYSIS.
4) LIST NAME OF FARM, FARM MANAGER & PHONE NUMBERS ON BACK OF FORM
FARM DIRECTIONS: MY FARM IS
MILES N S E W FROM
ON HIGHWAY
(CIRCLE ONE)
(TOWN)
PLEASE ENCLOSE A DETAILED MAP WITH LANDMARKS. TIME BECOMES CRITICAL FOR YOU AND FOR OUR INSPECTORS DURING
THE HARVEST. 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.
5) ENTER YOUR AREA FIELD INSPECTOR'S NAME:
6) (
YES, I DO) (
NO, I DON'T) WANT MY CERTIFIED ACREAGE TO BE SHOWN IN THE SEED DIRECTORY.
7) A SEED DEALER'S LICENSE OR CERTIFICATION PERMIT IS REQUIRED:
SEED DEALER'S LICENSE APPLICATION:
ENCLOSED
ON FILE
CERTIFICATION PERMIT APPLICATION:
ENCLOSED
ON FILE
8) OPERATE A SEED CLEANING FACILITY:
YES/NO
OPERATOR IN CHARGE:
9) FEES ENCLOSED:
$
PROMOTIONAL FEE ($0.10 PER ACRE)
$
ACREAGE ($1.50 PER ACRE FOR ALL CROPS EXCEPT RICE, WHICH IS $2.25 PER ACRE).
$ 20.00
VARIETAL FEE
$
LATE FEE
ADD $50.00 IF FILED AFTER DEADLINE (
SMALL GRAINS - APRIL 1; RICE & PEANUTS - JULY 1; SOYBEANS - AUG. 15)
$
TOTAL ENCLOSED
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 Web Site www.plantboard.org
ARKANSAS STATE PLANT BOARD
FORM 15
APPLICATION TO PRODUCE CERTIFIED SEED
(REV. 5/2014)
(COMPLETE ALL BLANKS)
NAME
PHONE(
)
FAX(
)
ADDRESS
UPS ADDRESS
EMAIL ADDRESS
1)
VARIETY & KIND
(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 BLUE TAG GRADE SEED.
2) LAND HISTORY (
) CHECK CIRCULAR 15 FOR LAND REQUIREMENTS.
USE THE BACK OF THE FORM TO LIST LAND HISTORY
COMPLETE FOR RICE - LAST 2 SUMMER CROPS
COMPLETE FOR SMALL GRAINS - LAST 2 WINTER CROPS
(EXCEPTION: IF LAND IS WINTER FALLOWED - SHOW LAST 2 SUMMER CROPS)
COMPLETE FOR SOYBEANS - PREVIOUS CROP GROWN
(EXCEPTION: IF THE PREVIOUS CROP WAS SOYBEANS, THE VARIETY MUST HAVE
BEEN PLANTED WITH CERTIFIED SEED OF THE SAME VARIETY OR ANOTHER VARIETY
WITH A DIFFERENT HILUM COLOR OR PUBESCENCE COLOR)
3) SEED SOURCE
PURCHASED SEED: SUBMIT A CERTIFIED LABEL FROM EACH LOT, COPY OF INVOICES SHOWING WHERE
SEED WAS ORIGINALLY PURCHASED, HOW MUCH SEED WAS PURCHASED, AND LOT NUMBERS.
OWN PRODUCTION SEED: ATTACH A COPY OF SEED LAB COMPLETE ANALYSIS.
4) LIST NAME OF FARM, FARM MANAGER & PHONE NUMBERS ON BACK OF FORM
FARM DIRECTIONS: MY FARM IS
MILES N S E W FROM
ON HIGHWAY
(CIRCLE ONE)
(TOWN)
PLEASE ENCLOSE A DETAILED MAP WITH LANDMARKS. TIME BECOMES CRITICAL FOR YOU AND FOR OUR INSPECTORS DURING
THE HARVEST. 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.
5) ENTER YOUR AREA FIELD INSPECTOR'S NAME:
6) (
YES, I DO) (
NO, I DON'T) WANT MY CERTIFIED ACREAGE TO BE SHOWN IN THE SEED DIRECTORY.
7) A SEED DEALER'S LICENSE OR CERTIFICATION PERMIT IS REQUIRED:
SEED DEALER'S LICENSE APPLICATION:
ENCLOSED
ON FILE
CERTIFICATION PERMIT APPLICATION:
ENCLOSED
ON FILE
8) OPERATE A SEED CLEANING FACILITY:
YES/NO
OPERATOR IN CHARGE:
9) FEES ENCLOSED:
$
PROMOTIONAL FEE ($0.10 PER ACRE)
$
ACREAGE ($1.50 PER ACRE FOR ALL CROPS EXCEPT RICE, WHICH IS $2.25 PER ACRE).
$ 20.00
VARIETAL FEE
$
LATE FEE
ADD $50.00 IF FILED AFTER DEADLINE (
SMALL GRAINS - APRIL 1; RICE & PEANUTS - JULY 1; SOYBEANS - AUG. 15)
$
TOTAL ENCLOSED
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 Web Site www.plantboard.org
CONTRACT GROWER INFORMATION
CONTRACT GROWER *
*
FARM NAME
(ONE PER APPLICATION)
PHONE #(
)
FAX #(
)
CELL/MOBIL PHONE #(
)
ADDRESS
ZIP
SEND AS PROOF, A CERTIFIED LABEL FROM EACH LOT PLANTED AND INVOICES AND/OR STATEMENTS SHOWING LOT NUMBER AND BUSHELS PURCHASED.
*COMPLETE TWO YEAR HISTORY FOR BOTH SUMMER OR WINTER CROPS FOR ALL CROPS EXCEPT SOYBEANS (CHECK CIR. 15 FOR CROP HISTORY REQUIRED)
VARIETY:
NUMBER
FIELD
GRADE
BUSHELS
CROP
CROP
CROP
CROP
NAME OF SEED
OF
NUMBER
PLANTED
PLANTED
LAST
LAST
SUMMER
WINTER
PLANTING
LOT
PRODUCER
ACRES
SUMMER*
WINTER*
BEFORE
BEFORE
DATE
NUMBER
ON THE LABEL OF THE
PLANTED
LAST*
LAST*
PLANTING SEED
GROWER
CITY NEAREST FIELD
TOTALS
ARKANSAS STATE PLANT BOARD
FIELD INSPECTION MAP
COMPANY:
CONTRACT GROWER:
FIELD DIRECTIONS:
MAP COORDINATES: Latitude
Longitude
N
S
Please use this form to show your field(s) unless you already have maps. Label each
field with Variety, Grade, and Acreage. Do not send in aerial photographs. County
maps showing all county roads are acceptable. Please make copies of form if
additional copies are needed.
PLEASE SEND IN A DETAILED MAP EVEN IF YOU
PLAN TO SHOW THE INSPECTOR(S) THE FIELDS.
Page of 3