Organic Seed Sourcing Attestation
Producer Information
Producer Name
Farm/Business Name
Certification Agency
Certification Number
Seed Sourcing Information
Cropping Year
Crop/Variety
Amount Needed (units)
Intended Use / Field Location
Organic Seed Source(s) Searched
Documentation of Seed Source(s) & Contact
Non-Organic Seed Use Justification
Describe why organic seed was not available (e.g., unavailable variety, quantity, quality)
List of Non-Organic Seeds Requested for Use
Seed Type/Variety
Supplier
Quantity
Untreated/Non-GMO Verified
Attestation
Name of Person Completing Form
Date
Signature