"Land Application Form" - Montana

Land Application Form is a legal document that was released by the Montana Department of Agriculture - a government authority operating within Montana.

Form Details:

  • Released on January 27, 2017;
  • The latest edition currently provided by the Montana Department of Agriculture;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Montana Department of Agriculture.

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Land Application
Electronic versions available at
agrorganic@mt.gov
Date:
Producer Name(s):
License # (Office Use Only):
Business Name:
Location/County/State:
Section A: Land Identification
• A distinct field, pasture, rangeland, circle, orchard block, or Contiguous area for which you seek
certification. May include multiple fields and crops if adjacent or contiguous.
1. Site Location – Provide directions to site.
Field ID: Example: Jones Farm, East Pivot
Address:
Township, Range, Section:
Please provide detailed directions to this site:
2. Land Status:
Organic – Land is under Organic management; no prohibited materials applied 36 months prior to
harvest.
Conversion – Land is transitioning to Organic
Section B: Land History
NOP.205.202
1. Do you own this land? Yes
skip to question 2 No
1a. Provide the name and contact information for the land owner:
1b. Describe the details of the lease (if verbal lease) OR attach a copy of the lease agreement:
1c. If you have not managed the land for 3 years prior to this year’s harvest a Previous Land Manager Affidavit
must be signed. This form can found at
http://agr.mt.gov
2. Has this site been previously or is it currently certified organic?
Yes
No, skip to question 3
2a. Certified business name:
2b. Certification agency and number:
2c. Site name and number as listed on certificate:
3. What date did you start making the day-to-day production decisions for this site?
If you have NOT managed this site for at least 3 years PRIOR to this year’s harvest, please have previous
managers complete and sign a Previous Land Managers Affidavit form.
Land Application.17V.2D 1/27/2017
Page 1 of 3
Land Application
Electronic versions available at
agrorganic@mt.gov
Date:
Producer Name(s):
License # (Office Use Only):
Business Name:
Location/County/State:
Section A: Land Identification
• A distinct field, pasture, rangeland, circle, orchard block, or Contiguous area for which you seek
certification. May include multiple fields and crops if adjacent or contiguous.
1. Site Location – Provide directions to site.
Field ID: Example: Jones Farm, East Pivot
Address:
Township, Range, Section:
Please provide detailed directions to this site:
2. Land Status:
Organic – Land is under Organic management; no prohibited materials applied 36 months prior to
harvest.
Conversion – Land is transitioning to Organic
Section B: Land History
NOP.205.202
1. Do you own this land? Yes
skip to question 2 No
1a. Provide the name and contact information for the land owner:
1b. Describe the details of the lease (if verbal lease) OR attach a copy of the lease agreement:
1c. If you have not managed the land for 3 years prior to this year’s harvest a Previous Land Manager Affidavit
must be signed. This form can found at
http://agr.mt.gov
2. Has this site been previously or is it currently certified organic?
Yes
No, skip to question 3
2a. Certified business name:
2b. Certification agency and number:
2c. Site name and number as listed on certificate:
3. What date did you start making the day-to-day production decisions for this site?
If you have NOT managed this site for at least 3 years PRIOR to this year’s harvest, please have previous
managers complete and sign a Previous Land Managers Affidavit form.
Land Application.17V.2D 1/27/2017
Page 1 of 3
Land Application
Electronic versions available at
agrorganic@mt.gov
Date:
Crop and Material Use History (Previous Three Years).
• Seed: GMO/NON GMO/Treated/Untreated
• Material: Inoculant/Herbicide/Fertilizers/Manure
Acreage
Prior Year Crop
Crop 2 years prior
Crop 3 years prior
Field ID:
Seed/Materials.
Seed/Materials.
Seed/Materials.
Year:
Year:
Year:
40 acres
Alfalfa,/ treated seed,
Ex: 1, north half
Alfalfa/None/ 2015
Alfalfa, manure/2014
/4/18/11.
40 acres
Lentils, Nodulator inoculant
Ex:1, south half
HRSW/None/2014
CRP/None/2013
2015
Section C: Land Map and Risk Assessment
NOP §205.202, 205.240(c)(4)
A map of your site must be submitted to complete your land application.(Google/FSA Maps Preferred)
1. How are site boundaries and buffer zones identified?
2. Evaluate all borders for risk of contamination with prohibited materials for neighboring lands:
Border
Adjoining Land Use
Identify Potential
Type & Width of
Crop Grown in
Risks
Buffer
Buffer
Ex: North
Conventional Wheat
None-Road Buffer
Y
N
North
Y
N
South
Y
N
East
Y
N
West
Y
N
3. Have you notified your neighbors that this site is in organic production?
Yes
No
4. Maps
Attached
Land Application.17V.2D 1/27/2017
Page 2 of 3
Land Application
Electronic versions available at
agrorganic@mt.gov
Date:
I attest that the information provided is complete and accurate to the best of my knowledge:
________________________________________________
______________________________
Signature of current producer
Date
________________________________________________
______________________________
Print name of current producer
Date
Map Example
Colored maps from Google Maps are preferred.
Map size must not exceed 8 ½ X 11 inches.
Maps for large tracts of land can be submitted in a similar manner that meets the requirements.
Show the border, shape and size of the site.
Identify locations of crops and fallow land.
Identify areas of erosion, woodlands, wetlands, wildlife habitat, invasive species
Indicate areas that separate your site from other land use such as roads, canals, fences and open land.
Identify all adjacent land use.
Identify and label borders at risk for contamination with prohibited materials.
Use the following symbols to indicate specific areas on the site map:
N↑
Site Border:
Border at Risk: XXXXXXXXX
Land Application.17V.2D 1/27/2017
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