SECTION I: APPLICANT INFORMATION 1.1. Operator name(s) (1) Limit of 2 names on certificate. (2)

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1 CERTIFICATION APPLICATION (2012) Note: Print or type all information legibly. Use blue ink. Applications will be returned if incomplete or illegible. There is an additional charge for resubmitted applications. If you download your application forms from the web, please be sure to download and read the Practice Manual and its Appendices. Copies of the Practice Manual are available free on-line or for a nominal fee, from MOFGA Certification Services. If a question does not apply to your operation enter N/A for not applicable. All questions must be answered. All requested attachments, labels and MSDS sheets must be included with your application. SECTION I: APPLICANT INFORMATION 1.1. Operator name(s) (1) Limit of 2 names on certificate. (2) Person in charge of day-to-day operations should be one of the names above. Name listed first will be the principal contact for this operation in our database. At least one of the individuals listed must be present and lead the annual inspections Farm or company name Mailing Address Town State/Province Zip/Postal Code County Country 1.3. Phone number Phone number for publication if different from above Cell phone number (not for publication) Fax Number for publication if different from above 1.5. Web URL 1.6. Farm or factory address/physical address (if different from mailing address) Address Town State Zip 1.7. Legal Status Sole Proprietorship Trust/Non-Profit Corporation LLC Cooperative Legal Partnership Other 1.8. Owner's name (if not one of the operators seeking certification) Phone Address Town State Zip If this is a farm operation and you do not own all of the parcels of land on which crops or livestock are produced, you will need to identify landowners on the Field History Forms and submit a New Field Verification of 3-yr History form. Page 1 of 7

2 1.9. What is the best way to contact you? Certification is being sought for the following (check all that apply): Crops (vegetables, herbs, flowers, grain, berries, hay etc.) Maple syrup Dairy Other Livestock and Livestock Products Mushrooms Honey Sprouts Wild harvest crop Processed Products (including handling operations, slaughterhouse & on-farm processors) doing any type of preservation, alteration, combination or packaging of agricultural products Have you ever had any farm products certified organic? Yes No. If YES, When was first year certified: Certifying Agent: Has this operation ever been certified under another organic producer? Yes No. If Yes, name of producer: List all current organic certifications by other agencies (include agency names): Have you ever been denied certification or had your certification suspended or revoked? Yes No If YES, what year(s)? What agency? You must enclose a copy of any notice of noncompliance or denial of certification and a description of the actions taken by you to correct any non-compliances. Page 2 of 7

3 1.15. Acres. We are interested in producing summary statistics about organic agricultural acreage. Please fill out the table below. You should be considering all of the acres that are under your management and are part of your farm operation, regardless of whether or not you own them. Your Farm Land Management Practice Organic Conventional Acres owned A. acres C. acres Acres leased B. acres D. acres A+B= C+D= The sum total of all acres reported in your Field History sheets should be no greater than the total acres you report as being managed organically (A+B) above (For example, you would not include wooded acreage if your application does not include a field history for the wooded acreage) What is the total acreage that you own? (Including wooded acreage etc) a) How many years of experience do you have farming? years. b) Briefly describe your own farming experience on your place. c) Briefly describe your own farming experience at other places Farm History. To the best of your knowledge, explain briefly the history (especially for the last 3 years) of the development and use of the land to be certified. Page 3 of 7

4 1.19. Please attach a map of your farm. This can be a NRCS map, aerial photograph, or drawn map. NRCS maps, available from your local NRCS office, are preferred. Maps should include and designate each of the following: a.) open land, woods, wetlands, bodies of water, and buildings; b.) nature of adjacent land; c.) all separately numbered or named fields or plots and their sizes including fields on which cover crops or conventional crops are grown; and, d.) locations of farm roads and public roads; e.) buffers, as needed. If you are a maple syrup producer or honey producer, identify sugar maple stands and hives on your maps, respectively. If you are a livestock producer, identify all structures that house animals. NOTE: if you are using aerial photography, please provide an overall map showing field locations relative to each other. NOTE: If you draw a map of your farm be as accurate as you can Give directions to your farm for your inspector to follow. Inspectors have found that a photocopy of the Delorme Atlas or any other map marked with the farm or facility s location can be very helpful Are you certifying fields that are a distance from your farm? Please state the distance and the driving time from the farm Do you work with a crop consultant or farm advisor? If yes, please provide your consultants name and contact information. Page 4 of 7

5 SECTION II. OVERVIEW PRODUCTS AND SERVICES This section provides MOFGA Certification Services a quick summary of your activities, and guides you to the other sections of the application that you need to complete. Check () each product category for which you are seeking certification and complete the questions. Make sure you then complete the appropriate form(s) for each category CROP PRODUCTION. Fill out the FARM PLAN. Write in total acreage of each item below for which you seek organic certification. If producing lowbush blueberries complete a blueberry farm plan. acres Vegetables & Herbs acres Grains acres Pasture acres Hay Crops (all preservation methods) acres Flowers SqFt Greenhouse acres Berries Other acres Tree (Fruits & Nuts) acres Nursery Crops/Christmas Trees When does your harvest begin? (date) Which crop? 2.2. DAIRY (MILK) PRODUCTION (fill out DAIRY SUPPLEMENT) Approximate amount of milk produced annually (If you want to certify any other livestock (e.g. veal calves, cull cows for beef), see 2.3 below.) 2.3. CERTIFIED LIVESTOCK PRODUCTS, other than dairy (fill out LIVESTOCK SUPPLEMENT) List principle animal products for which you seek certification (replacement animals, meat, eggs, etc.) below. Livestock Product lbs. Expected Amount (annual) 2.4. PROCESSED PRODUCTS (fill out PROCESSOR SUPPLEMENT/ ON-FARM PROCESSING SUPPLEMENT) Estimate production in the table below. Processed Products Expected Amount (annual) (use categories like breads or jams or dried herbal products ) 2.5. MAPLE SYRUP (fill out MAPLE SYRUP SYSTEM PLAN) Total acreage of sugar bush Estimate of total number of taps 2.6. HONEY (fill out HONEY SUPPLEMENT) Number of hives Estimate amount of honey produced for year 2.7. MUSHROOMS (fill out MUSHROOM SUPPLEMENT) Estimate total amount to be produced this year 2.8. SPROUTS (fill out SPROUTS SUPPLEMENT) Estimate total amount to be produced this year 2.9. WILD CROP (fill out WILD CROP HARVEST SUPPLEMENT) Estimate total amount to be harvested this year CONVENTIONAL (NON-ORGANIC) PRODUCTION If you produce any products conventionally, you must check () this box. This includes categories previously identified as transitional, parallel, and split operations Request Export Certificates to Japan to Taiwan: If you wish this office to issue export certificates for any products please indicate which country and refer to Part 5 of the Practice Manual. You must fill out a Request for Export Certificate Form for each export transaction. Page 5 of 7

6 SECTION III. MARKET INFORMATION 3.1 Below is a list of some common types of markets where organic producers sell products. Please select the markets where you sell your products (or are planning to sell your products) and specify (name) these markets. This information will be published and used by MOFGA s marketing specialist. If you do not want this information to be published, please use the do not publish column. Market Type Check all that apply Please Specify (name) CSA Do not publish Senior Shares Farm Shares Fairs & Festivals Farmers Cooperatives Farmers Markets Institutions (e.g., schools) Mail Order/Phone/Web Natural Food Stores On-Farm (farm stand, farm store) Other farmers Processors Restaurants Specialty shops Supermarkets Trade or Barter Wholesalers (e.g., Horizon Milk) Distributors Other: Page 6 of 7

7 3.2. Do you have a catalog or brochure? Yes No. If YES, please attach a copy Do you sell crops or products produced and harvested by other farms? Yes No. If YES, please complete the following: Product Source ORGANIC? CERTIFIED? CERTIFIED BY WHOM? Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No 3.4. If you sell any conventional (non-organic) products, please list and specify if you want these products published If you are selling conventional (non-organic) products, what steps are you taking to separate and identify these products from your organic products when you prepare goods for sale and when you present goods for sale? Signature of Producer Date Signature of Producer Date Page 7 of 7