<p> 1900 Hendon Avenue St. Paul MN 55108 612/625-7766 800-510-MCIA Fax 612/625-3748 E-Mail: [email protected] Internet Address: http://www.mncia.org</p><p>DECLARATION OF CARRYOVER SEED</p><p>Report carryover of seed eligible for certification by August 15 of the calendar year following production to maintain its eligibility for certification. If certification is applied for more than 3 years after filing this declaration, a copy of the inspection report must be furnished with the application.</p><p>Member number: </p><p>Applicant: </p><p>Address: </p><p>Variety and crop: </p><p>Seed class (check one): Foundation Registered Certified</p><p>Year produced: </p><p>Grower name: </p><p>Field number: </p><p>Acres in field: </p><p>Total bushels produced from this field: </p><p>Bushels from this field previously certified: </p><p>Total bushels carried over from this field: </p><p>Applicant's signature: ______Date: </p><p>Declaration of Carryover Seed Page 1 of 1 Print Date: 4/6/2018 Controlled Version – 5/26/05 © 2005 Minnesota Crop Improvement Association</p>