Form DL-22 "Certificate of Ownership/Movement of Agricultural Commodities" - Hawaii

What Is Form DL-22?

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

Form Details:

  • Released on August 1, 2016;
  • The latest edition provided by the Hawaii Department of Agriculture;
  • 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 DL-22 by clicking the link below or browse more documents and templates provided by the Hawaii Department of Agriculture.

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Download Form DL-22 "Certificate of Ownership/Movement of Agricultural Commodities" - Hawaii

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DL-22
DL-22
08/16
08/16
CERTIFICATE OF OWNERSHIP/MOVEMENT
CERTIFICATE OF OWNERSHIP/MOVEMENT
OF AGRICULTURAL COMMODITIES
OF AGRICULTURAL COMMODITIES
Quality Assurance Division / Commodities Branch
Quality Assurance Division / Commodities Branch
This certifi cate is required if you sell any amount of an agricultural product that is to be marketed for
This certifi cate is required if you sell any amount of an agricultural product that is to be marketed for
commercial purposes; or transport agricultural commodities with a weight greater than 200 pounds or
commercial purposes; or transport agricultural commodities with a weight greater than 200 pounds or
with a value of $100 or more.
with a value of $100 or more.
OWNER
GROWER
SELLER:
OWNER
GROWER
SELLER:
BUYER
RECEIVER:
BUYER
RECEIVER:
__________________________________
__________________________________
__________________________________
__________________________________
Name
Name
Name
Name
__________________________________
__________________________________
__________________________________
__________________________________
Residence Street Address
Street Address
Residence Street Address
Street Address
__________________________________
__________________________________
__________________________________
__________________________________
City, State, Zip Code
City, State, Zip Code
City, State, Zip Code
City, State, Zip Code
__________________________________
__________________________________
__________________________________
__________________________________
Phone No.
Transport Vehicle License No.
Phone No.
Phone No.
Transport Vehicle License No.
Phone No.
Price/unit
Amount
Price/unit
Amount
Quantity
Quantity
Product Description
Product Description
(optional)
(optional)
(optional)
(optional)
TOTAL AMOUNT DUE (OPTIONAL)
TOTAL AMOUNT DUE (OPTIONAL)
ORIGIN OF PRODUCT(S) - Name of Farm Owner and Physical Address (or TMK):
ORIGIN OF PRODUCT(S) - Name of Farm Owner and Physical Address (or TMK):
The information above is factual and correct to the best of my knowledge.
The information above is factual and correct to the best of my knowledge.
Print Name (Seller)
Signature (Seller)
Date
Print Name (Seller)
Signature (Seller)
Date
Print Name (Buyer)
Signature (Buyer)
Date
Print Name (Buyer)
Signature (Buyer)
Date
Two copies of this certifi cate must accompany the shipment and one copy is to be retained by the person
Two copies of this certifi cate must accompany the shipment and one copy is to be retained by the person
completing the certifi cate. False information or failure to comply may result in criminal prosecution as
completing the certifi cate. False information or failure to comply may result in criminal prosecution as
provided in Chapter 145, Part II Hawaii Revised Statutes.
provided in Chapter 145, Part II Hawaii Revised Statutes.
DL-22
DL-22
08/16
08/16
CERTIFICATE OF OWNERSHIP/MOVEMENT
CERTIFICATE OF OWNERSHIP/MOVEMENT
OF AGRICULTURAL COMMODITIES
OF AGRICULTURAL COMMODITIES
Quality Assurance Division / Commodities Branch
Quality Assurance Division / Commodities Branch
This certifi cate is required if you sell any amount of an agricultural product that is to be marketed for
This certifi cate is required if you sell any amount of an agricultural product that is to be marketed for
commercial purposes; or transport agricultural commodities with a weight greater than 200 pounds or
commercial purposes; or transport agricultural commodities with a weight greater than 200 pounds or
with a value of $100 or more.
with a value of $100 or more.
OWNER
GROWER
SELLER:
OWNER
GROWER
SELLER:
BUYER
RECEIVER:
BUYER
RECEIVER:
__________________________________
__________________________________
__________________________________
__________________________________
Name
Name
Name
Name
__________________________________
__________________________________
__________________________________
__________________________________
Residence Street Address
Street Address
Residence Street Address
Street Address
__________________________________
__________________________________
__________________________________
__________________________________
City, State, Zip Code
City, State, Zip Code
City, State, Zip Code
City, State, Zip Code
__________________________________
__________________________________
__________________________________
__________________________________
Phone No.
Transport Vehicle License No.
Phone No.
Phone No.
Transport Vehicle License No.
Phone No.
Price/unit
Amount
Price/unit
Amount
Quantity
Quantity
Product Description
Product Description
(optional)
(optional)
(optional)
(optional)
TOTAL AMOUNT DUE (OPTIONAL)
TOTAL AMOUNT DUE (OPTIONAL)
ORIGIN OF PRODUCT(S) - Name of Farm Owner and Physical Address (or TMK):
ORIGIN OF PRODUCT(S) - Name of Farm Owner and Physical Address (or TMK):
The information above is factual and correct to the best of my knowledge.
The information above is factual and correct to the best of my knowledge.
Print Name (Seller)
Signature (Seller)
Date
Print Name (Seller)
Signature (Seller)
Date
Print Name (Buyer)
Signature (Buyer)
Date
Print Name (Buyer)
Signature (Buyer)
Date
Two copies of this certifi cate must accompany the shipment and one copy is to be retained by the person
Two copies of this certifi cate must accompany the shipment and one copy is to be retained by the person
completing the certifi cate. False information or failure to comply may result in criminal prosecution as
completing the certifi cate. False information or failure to comply may result in criminal prosecution as
provided in Chapter 145, Part II Hawaii Revised Statutes.
provided in Chapter 145, Part II Hawaii Revised Statutes.