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