Application For Organic Certification

New Mexico Department of Agriculture, Organic Program

4501 Indian School Rd NE, Suite 100, Room G104 Albuquerque, NM 87110 (505) 889-9924 / (575) 646-0339 (Please use your tab key to navigate through the form)

2013 APPLICATION FOR ORGANIC CERTIFICATION NON-RUMINANT LI VESTOCK RANCH OR BUSINESS NAME: COUNTY:

RANCHER’S NAME: PHONE NUMBER: TITLE:

CONTACT NAME (IF DIFFERENT FROM ABOVE): PHONE NUMBER: TITLE:

FOREMAN/ MANAGER (IF DIFFERENT FROM ABOVE): PHONE NUMBER: TITLE:

MAILING ADDRESS :

CITY: STATE: ZIP CODE:

PHYSICAL ADDRESS/ LOCATION OF RANCH:

CELL PHONE NUMBER (IF DIFFERENT FROM ABOVE): ALTERNATE PHONE NUMBER:

FAX NUMBER:

EMAIL ADDRESS: @

WEBSITE:

BUSINESS INFORMATION : EDUCATIONAL INSTITUTION / PUBLIC INSTITUTION / INDIVIDUAL (SOLE PROPRIETORSHIP) NONPROFIT

INDIVIDUAL “DOING BUSINESS AS” GENERAL PARTNERSHIP.

CORPORATION COOP

LIMITED LIABILITY COMPANY (LLC) OTHER: (PLEASE LIST)

DOC C102 version k – Eff. Date 2/1/13 NMDA Organic Non-Ruminant Livestock Application New Mexico Department of Agriculture, Organic Program

AFFIRMATION OF ORGANIC APPLICANT

(The person signing the Affirmation Agreement must be authorized to represent the business.) I, , as an authorized representative of [Business Name] depose and say that I will: 1. Fully comply with all applicable organic production and handling regulations in accordance with Title 7 CFR Part 205 National Organic Program Rule.

2. Establish, implement, and update annually an organic production or handling system plan that will be submitted to New Mexico Department of Agriculture (NMDA).

3. Supply NMDA with all information required to verify compliance with the National Organic Program Rule.

4. Permit on-site inspections with complete access to the production or handling operation, including noncertified production and handling areas, structures, and offices by NMDA inspectors. These inspections may be announced or unannounced at the discretion of NMDA or as required by the Administrator of the National Organic Program.

5. Maintain all records applicable to the organic operation for not less than five (5) years beyond their creation.

6. Allow authorized representatives of NMDA, or the US Secretary of Agriculture access to these records under normal business hours for review and copying to determine compliance with the National Organic Program Rule.

7. Submit to NMDA the applicable fees as described on the fee schedule which is current at time of payment.

8. Immediately notify NMDA about any application, including drift, of a prohibited substance to any field, production unit, site, facility, livestock, or part of an operation.

9. Immediately notify NMDA of any change in our certified operation or portion of it that may affect its compliance with the National Organic Program Rule, including: additions or deletions of crops & fields; facilities, ingredients & products, changes to managers, responsible parties, contact information and email address.

I understand that willful violation of organic rules and regulations may result in revoking of organic certification and in extreme cases may lead to state and federal fines and penalties.

I understand that receipt of this application in no way implies granting of certification by NMDA.

If new or additional fields/products are added after the annual inspection is complete, additional costs will be incurred. If a second inspection is necessary the requesting producer will be billed for the actual cost of the inspection ($225 plus inspector’s mileage & expenses) and the actual cost of DOC C102 version k – Eff. Date 2/1/13 NMDA Organic Non-Ruminant Livestock Application New Mexico Department of Agriculture, Organic Program the office audit ($40/hr) to complete the addition. In cases where no second inspection is required, the requesting producer will be billed for the actual cost of the desk audit ($40/hr). Payment must be received before the new or additional fields/products are certified organic and added to Organic Product List and the Organic System Plan.

SIGNATURE OF AUTHORIZED REPRESENTATIVE: DATE:

PRINT NAME : TITLE:

ASSESSMENT FEE is three-fourths of one percent (¾ percent) of the first million dollars of gross organic sales, plus seventy-five one thousandths of one percent of the gross organic sales over one million dollars. Total Gross Certified Organic Sales for the 2012 A: Calendar Year (Jan. 1, 2012 – Dec. 31, 2012) rounded to the nearest dollar B: For sales between zero and $0 to $1,000,000 (one the first one million dollars, million) multiply Box A amount by . 0075

Are gross organic sales over one If “No”, enter amount from box B Yes No million dollars? into box D If “Yes”, your total assessment is the sum of the assessment on your first one million dollars (box B), plus the assessment on sales over your first one million dollars (box C).

For sales over one million C: Over $1,000,000 (one dollars, multiply the million) amount over one million by .00075 D: Total Organic Sales Assessment Fee (the sum of box B & C) =

LATE FEE for RENEWAL applications postmarked after May 1, 2011

Late Fee: renewals received after May 1, $75.00 2013 Late Fee: renewals received after June 1, $100.00 Late fees apply to 2013 Late Fee: renewals received after July 1, 2013 $200.00 RENEWAL applicants only. Late Fee: renewals received after August 1, $500.00 2013 E: (Enter amount checked above) Total Late Fees = APPLICATION FEE If you were Certified Organic in 2012, please report your 2012 ORGANIC SALES & YIELDS ● Sales include CSA, farmer’s markets, restaurants, on-farm stand, distributors, grocery stores, internet, etc. ● Please list all products separately ( beef - whole, sides or cuts, hay, etc). ● Please include sales of live organic animals SALES CROP YIELD ACRES (rounded to nearest dollar) example: native grass hay 450 tons 300 $ Pounds Pounds Pounds Pounds Pounds Pounds Pounds Pounds

NUMBER SALES LIVESTOCK & PRODUCTS YIELD OF (rounded to nearest ANIMALS dollar) Not yet 18 sows, 2 example: swine $ slaughtered gilts 30 hens 1 chicken eggs 400 dozen rooster

Total Certified Organic Sales 2012 $ Percenta Type of Sales Number Type of Employee ge of of Sales employee s % Farmers Markets Permanent Full Time Employees % On-Farm Sales Permanent Part Time Employees % CSA (Community Supported Seasonal Employees Agriculture) % Wholesale % Restaurant Marketing & Jobs - Help us show state % Retail Stores government the importance of organic farming in New Mexico’s economy % Other please specify:

DOC C102 version k – Eff. Date 2/1/13 NMDA Organic Non-Ruminant Livestock Application