Washington State Department of Agriculture Organic Food Program PO Box 42560; 1111 Washington Street SE Olympia, WA 98504-2560 (360) 902-1805, [email protected] http://agr.wa.gov/foodanimal/organic ORGANIC LABEL APPROVAL VERIFICATION All packaged products making organic claims on the principal display panel must be approved by a USDA Organic Certification Agency prior to distribution into the market place. This form is used to confirm the USDA certification agency displayed on the label has reviewed and approved the label as compliant with USDA organic regulations. One form is required per label design.

Business seeking verification of label approval Certification number

USDA organic certification agency identified on the label

Brand name on label

Product name on label

Final handler or distributor name and address on label

Lot numbers, SKU, or other identification marks on label

Package size(s) of label

Attach a picture of the principal display panel of the label so that the organic claims are visible. To attach pictures click the image icon ( ) in the box below

AGR 2724 (N/11/17) Organic Label Approval Verification Page 2 of 2 Washington State Department of Agriculture Organic Food Program PO Box 42560; 1111 Washington Street SE Olympia, WA 98504-2560 (360) 902-1805, [email protected] http://agr.wa.gov/foodanimal/organic ORGANIC LABEL APPROVAL VERIFICATION Attach a picture of the information panel so that the ingredient statement is visible (if not legible in the picture above).

USDA Organic Certification Agency Statement of Approval The section below must be completed by the certification agency listed on the label.

By typing your name below and submitting this form, you attest that this label is compliant with USDA organic regulations noted below and the use of your certification agency's name has been approved.

Print name Date

USDA organic certification agency Title

This label has been reviewed to the following standards

Packaged products labeled “100 percent organic” or “organic.” [NOS 205.303]

Packaged products labeled “made with organic (specified ingredients or food group(s)).” [NOS 205.304]

Multi-ingredient packaged products with less than 70 percent organically produced ingredients. [NOS 205.305]

Labeling of livestock feed. [NOS 205.306]

Other (please specify):

Additional notes on label approval:

AGR 2724 (N/11/17) Organic Label Approval Verification Page 2 of 2 Washington State Department of Agriculture Organic Food Program PO Box 42560; 1111 Washington Street SE Olympia, WA 98504-2560 (360) 902-1805, [email protected] http://agr.wa.gov/foodanimal/organic ORGANIC LABEL APPROVAL VERIFICATION

AGR 2724 (N/11/17) Organic Label Approval Verification Page 2 of 2