ATTRA

Forms, Documents, and Sample

Letters for Organic Producers

A Publication of ATTRA, the National Sustainable Agriculture Information Service 1-800-346-9140 www.attra.ncat.org
By George Kuepper,
NCAT Agriculture
Specialist;
Jim Riddle and
Joyce Ford,
Organic
Independents;
Cissy Bowman,
Indiana Certied
Organic;
and Meg Moynihan,
Minnesota
Department of
Agriculture
NCAT 2005

Organic farmers and ranchers must provide a wide range of documents to retain certication by the
National Organic Program. This publication provides sample copies of some common forms, letters,
maps, and other documents in current use.

The Purpose and Use of

These Forms and
Documents

his publication contains draft letters,

forms, and other documents that can
aid producers in obtaining organic
certication and remaining in compliance
with the National Organic Standard. We
are grateful to Organic Independents, Indiana Certied Organic, and the Minnesota
Department of Agriculture for granting perRelated ATTRA Publications
Organic Field Crops Documentation Forms
www.attra.ncat.org/attra-pub/cropforms.html
Organic Livestock Documentation Forms
www.attra.ncat.org/attra-pub/
livestockforms.html
Organic Orchard, Vineyard, and Berry Crop
Documentation Forms
www.attra.ncat.org/attra-pub/
orchardforms.html
NCATs Organic Crops Workbook
www.attra.ncat.org/attra-pub/PDF/
cropsworkbook.pdf

ATTRA is the national sustainable agriculture information

service operated by the National
Center for Appropriate Technology, through a grant from the
Rural Business-Cooperative Service, U.S. Department of Agriculture. These organizations do not
recommend or endorse products, companies, or individuals. NCAT has oces
in Fayetteville, Arkansas,
Butte, Montana, and

Davis, California.

NCATs Organic Livestock Workbook

www.attra.ncat.org/attra-pub/PDF/
livestockworkbook.pdf
Creating an Organic Production and Handling
System Plan: A Guide to Organic
Plan Templates
www.attra.ncat.org/attra-pub/
handlingsys.html

mission to reprint and adapt these materials. Feel free to copy or adapt any of these
documents to meet your needs.
This set of forms and documents contains
the following.
A. Land Use History Verication. Use to
verify that land has not received applications of prohibited substances in the
previous 36 months. Also use this form
when you have rented or owned the land
for less than 36 months. In such cases,
the landlord or previous owner must ll
out and sign the form.
B. Neighbor Notication Letter. Use
in conjunction with the verication
of adjoining land use form to establish the integrity of elds bordering
low-risk conventional land. Depending on the circumstances, these documents can eliminate the need for buffer zones.
C. Adjoining Land Use Verication. See
neighbor notication letter above.
Two options are presented.
D. Clean Transport Afdavit. Required
of producers and handlers who are
responsible for transport of organic
products.
E. Complaint Log. This log is used
to track complaints and show actions
taken,as required under ISO 65.

F. GMO-Free AfdavitProduction. Used

to verify non-use of genetically engineered materials on the farm.
G. GMO-Free AfdavitInput Purchases.
Used to verify the absence of genetically modied organisms in purchased
inputs.
H. Transaction Certicate (TC) Authorization. Producers, certiers, and buyers
use TCs to track organic products from
farm to nal buyer. TCs are part of
a good audit trail, though not all certiers require them.
I. Sample Farm Inspection Report Form.
An example showing the kinds of information reported to certiers following
a farm or ranch inspection.
J. Sample Farm Map. A farm or ranch
map is required when applying for certication. This example shows the
level of required detail.
K. Exempt Organic Farm Afdavit. For
use by farms that market $5000 or
less of organic products annually and
do not choose to become certied.
This document attests to exempt status.
These documents may be copied and distributed freely. They may be downloaded from
the ATTRA Web site at www.attra.ncat.org.
Additional hardcopies are also available by
writing ATTRA at P.O. Box 3657, Fayetteville, AR 72702, or by calling 1-800-3469140 toll-free.
Acknowledgements: This publication was
developed with support from the USDAs
Risk Management Agency. Special thanks to
NCAT Agriculture Specialists Barbara Bellows, Ann Baier, and Holly Born for their
assistance.

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Forms, Documents, and Sample Letters for Organic Producers

Land Use History Verication

Organic Producer Name:

Crop Production Year:

I,
, declare that the parcel(s) of land described below were
farmed by me or were under my control during the crop years of
to
. I also declare that
during this time, to the best of my knowledge, there were no herbicides, pesticides, fungicides, fungicide treated
seed, synthetic fertilizers, or other prohibited materials applied to this land.
Description of land parcel(s) by eld #, section #, township, and county (or other regulatory description):

Number of acres in parcel(s):

If any materials were applied to any of these elds, describe what was applied, the specic date of application,
and eld # or parcel.
Field # or Parcel

Material Applied

Date

I submit that the above is true and accurate on this date of

Name (printed):
Signature:

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Date

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NEIGHBOR NOTIFICATION LETTER

(Date)

(Name and address)

Dear (Name):
I am currently a certied organic farmer with
(name of
your certifying agent), managing my elds consistent with the USDA National Organic Standard.
Since you are an adjoining property owner, I need to inform you of my plans and ask for your help. If you
plan to use synthetic fertilizers, pesticides, and/or genetically engineered crops on land that adjoins my
elds, please take precautions when transporting or spraying to prevent overspray, chemical or genetic drift,
or run-off onto my farm. If chemical drift is found on my organic crops or elds, I may be required to wait
up to three years before using these elds for organic production. This could also cause loss of my organic
certication and/or loss of the organic premium for crops grown on affected elds.
(Optional Paragraph) I understand that you are currently not using any synthetic fertilizers, pesticides, and/
or genetically engineered crops on the (eld or pasture) that borders my farm to the
(east, west,
north or south) and adjoins my eld #(
). If you are willing to sign the enclosed Verication Of
Neighboring Land Use form, I will not be required to maintain a buffer zone between your eld and mine.
Also indicate the location of your adjoining elds on the map enclosed. Please return the signed statement
as soon as possible.
If you would like to know more about my organic certication or have any other questions, please call. Thanks
for your help.
Sincerely
(Signature of organic farmer)
Enc.: Verication of adjoining Land Use form
Farm map

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Forms, Documents, and Sample Letters for Organic Producers

ADJOINING LAND USE VERIFICATION

(Optional Form A)

Name of Neighbor
Address
Phone #
I verify that the following elds/areas under my management have had no synthetic fertilizers, herbicides,
insecticides, or genetically engineered crops applied in the last 12 months. I have no plans to use these
synthetic products on these elds in the future 12 months. In the event that I do use any synthetic fertilizers, herbicides, insecticides, or genetically engineered crops, I will inform
(name of organic farmer) of my plans.
Specic Field Identication: (The organic farmer should indicate the organic eld ID # that adjoins a neighbors
elds before sending this document to that neighbor and indicate elds on the accompanying eld map).
Organic eld ID #

Neighbors eld identication

I verify that the above information is true and accurate.

Signature of Neighbor

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Date Signed

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ADJOINING LAND USE VERIFICATION

(Optional Form B)

I verify that I am the farmer of Location

I am aware that my neighbor,
(name), whose land borders my farm(s) on the
(N,E,S, and/or W) side(s) is certied organic. I also understand that it is important to his or her
business that organic crops and land be protected from contact with certain substancessuch as synthetic
fertilizers, herbicides, insecticides, fungicides, other pesticides and genetically modied organismsthat are
not allowed in organic farming. Buffer zones are required to be sufcient to prevent contamination.
The following statements on this afdavit will help the organic certier determine what type of buffer the
organic farmer named above needs to maintain. Please check all that are true.
I am an organic farmer, with current certication by

(name of certier).

The materials I routinely use on my farm include the following:

synthetic fertilizers
herbicides
insecticides
fungicides
treated wood
other (specify)
I do not use any of the above materials on my farm
I use the materials checked above, but not on the elds adjoining my neighbors property.
is

The distance between where I use the materials checked above and my organic neighbors property
feet.
I agree to notify my organic neighbor when I plan to use these materials on adjacent land.

Signature of neighbor

Date

Farm Name
Address
Phone number

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Forms, Documents, and Sample Letters for Organic Producers

CLEAN TRANSPORT AFFIDAVIT

Grower/Business Name:
Date transport unit loaded:
1. Type of transport:

farm wagons

common carrier

tanker

2. The transportation was arranged by:

farm truck

bulk semi trailer

other (specify)
grower

buyer

3. Is the form of transportation only used for organic products?

If no, state products transported prior to organic:

other
yes

no

4. Transport unit was inspected and found to be free of:

foreign odors

residues

conventional products

other substances which may compromise organic integrity

5. List transport unit ID # with the following information:
Transport unit Organic crop
/vehicle
and Lot #
identication

Check () if vehicle
was inspected prior
to loading organic
product

Cleaning method: Check () all that apply. If Other,

describe method.
Swept Vacuum Air blown Washed Other

I hereby certify that the above transport units were inspected and cleaned thoroughly using the method indicated to protect the integrity of the organic products being transported.

Signature

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Date

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COMPLAINT LOG
Organic Producer Name:

Complaint

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Date
Received

Source of
Complaint

Action Taken

Date of
Action

Employee

Forms, Documents, and Sample Letters for Organic Producers

GMO-Free Adavit: Organic Production

I,

, do hereby attest that I did not knowingly apply or use any

genetically modied organisms (GMOs) or products derived from genetically modied organisms, such as
GE seed, inoculants, or biopesticides, in any aspect of my organic production. I have taken precautions to
prevent GMO contamination and commingling and have included a description of the documentation I will
retain in my organic plan.
Signed:
Please Print Name:
Farm/Operation Name:
Certicate Number:

e-mail:
Date:

Address:

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GMO-Free Adavit: Agricultural Inputs

I,

, do hereby attest that

[product name] does not contain GMOs (AKA genetically manipulated organ-

isms, genetically engineered products, or biotech products) nor has it been manufactured using genetically
engineered organisms.

Signed:

Date:

Please Print Name:

Business Name:
Address:

Phone:

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E-mail:

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Forms, Documents, and Sample Letters for Organic Producers

TRANSACTION CERTIFICATE AUTHORIZATION DOCUMENT

DATE:

BUYERS NAME:
ADDRESS:
PHONE:

FAX:

PRODUCER/PROCESSOR #:
PRODUCT/
COMMODITY

CROP
YEAR

DATE OF TRANSACTION:
QUANTITY

UNIT OF
MEASURE

US $ PAID
(0ptional)

LOT#

PRODUCER #
(PROCESSORS
ONLY)

OTHER PRODUCER NUMBER/TC NUMBER, IF THE SELLER IS A CORPORATE OPERATOR

SELLER NAME:
ADDRESS:
PHONE:
PRODUCER #:

FAX:
SELLER SIGNATURE:

ALL INFORMATION REQUESTED ON THIS DOCUMENT MUST BE COMPLETED. (This TC is not complete until it is returned to the certier and signed by an authorized representative.)

Signature of Certier Representative

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Sample Farm Inspection Report Form

Certier:
Farmer/Farm:
Address:
Phone:
Fax:
E-mail:
Producer #:
Date of Visit:
Independent Inspector:

Start Time:

Stop Time:
Inspector Number:

1)

Verication of Questionnaire:
(Name) has requested (Certier) certication of the following:
acres of (crop)
The questionnaire
was
was not complete.

2)

Situation and Management

Details of land ownership, rental, and equipment. Is equipment used on conventional acreage as well? Is
farm 100% organic? (transitional?) (conventional?)

3)

Soil Building Program/Crop Rotation/Fertility

Describe rotation. Do Field History sheets back up description? Are cover crops used? What is used to
improve fertility?

4)

Crop Condition/Seed Sources

Note condition of crops and details on undersowing. Is GMO seed used on the farm? Treated seed?
Inoculation?

5)

Pasture land
How much? What crops? Details on grazing, if applicable.

6)

Woodlands/Wetlands
How do you protect natural resources and biodiversity?

7)

Manure Management
Details

8)

Weed Management
Describe

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Forms, Documents, and Sample Letters for Organic Producers

9)

Pest Management
Describe

10) Disease Management

Describe
11) Irrigation
Details
12) Harvest/Post-Harvest Handling/Storage
Details on equipment cleaning, storage, bin numbering, and records
13) Livestock
How many? What kind? Is certication being sought? How and where is the livestock procured? What
products are used? What are the living conditions?
14) Audit Trail
A) Field RecordsDetails
B) Purchased InputsComments on farm applications enclosures and labels
C) Bin and Lot NumbersDescribe
D) Transaction Certicates or other transaction recordsWhat is being used? Clean truck
certicates?
E) On-Farm Retail/ResaleDetails on records for on-farm and other sales records
F) Tracing ProductInspector traces a harvested crop from certain elds in the past year through
the farmers records. Comments on traceability and records.
G) In/Out Audit or Production Verication Audit
15) Split/Parallel Production and Buffer Zones
Describe how applicant segregates crops, uses buffer zones, and keeps records to ensure no contamination
or commingling.
16) On-Farm Processing
Is it done? Is it for only this growers crops? Is any conventional crop processed? Is it certied organic?
17) Conversion and Farm Goals
Is organic production going to expand? How and when?
18) Crop Improvement Needs
Where is improvement needed?

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19) Standards Adherence Are standards met? Are any prohibited substances used? Is there suspicion of use
of prohibited substances and/or practices or other contamination that should be investigated?
20) Comments
Additional information.
21) Appendices
How many enclosures are with report?
22) Results/notes from the Exit Interview

Signature

Date

Inspector #
Peer Evaluator:
Note: The information contained in this report is condential and between the inspector, the inspected
party, and AUTHORIZED personnel employed by the certier. Information was gathered from provided
documentation, direct observation, and directly from the inspected party. Any other use is unauthorized and may be subject to legal action.

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Forms, Documents, and Sample Letters for Organic Producers

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Exempt Organic Farm Adavit

I,
, sell no more than $5000.00 of agricultural products
labeled or represented as organic, annually.
I attest that all of my production and handling practices and inputs associated with these organic products are in compliance with the National Organic Standard, 7 C.F.R. Part 205. Therefore, my practices
include but are not limited to the following.
a complete prohibition on all synthetic fertilizers, pesticides, herbicides, and growth regulators, except
for those approved by the National Organic Program and placed on the National List, 205.601
a complete prohibition on the use of arsenic- and lead-based pesticides, nicotine- and strychnine-based
pesticides and baits, and sewage sludge fertilizer
use of seeds and planting stock that have not been genetically engineered or treated with prohibited
pesticides
preventing crop contamination from prohibited spray drift
preventing commingling of organic with conventional production
strategies that build soil, prevent erosion, and promote biodiversity
keeping adequate records to demonstrate compliance with the National Organic Standard
I further attest that my organic products are not used as ingredients in certied organic processed products, nor are they used as feed for certied organic livestock.
Signature:

Date:

Print name:
Address:

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Forms, Documents, and Sample Letters for Organic Producers

NOTES

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NOTES

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Forms, Documents, and Sample Letters for Organic Producers

NOTES

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NOTES

Forms, Documents, and Sample Letters for Organic

Producers
By George Kuepper, NCAT Agriculture Specialist
Jim Riddle and Joyce Ford, Organic Independents;
Cissy Bowman, Indiana Certied Organic;
and Meg Moynihan, Minnesota Department of
Agriculture.
NCAT 2005
Paul Williams, Editor
Cynthia Arnold, Production
This publication is available on the Web at
www.attra.ncat.org/attra-pub/producerforms.html
or
www.attra.ncat.org/attra-pub/PDF/producerforms.pdf
IP276
Slot276
Version 081505

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