SSCASouthern Seed

Certification

Association

Application for Certification	of Turfgrass

Submit an Application for each crop kind, variety and Certified class

Attach Form "A" for Contract growers

Applicant ______________________________________	Date _______________

Address	______________________________________	County _____________

______________________________________	Phone Day __________

Night ______________

Directions to Farm:

Mobile _____________

_______ Miles __________ From ___________________

N.E.S.W. Town	Hwy. No. ___________

New Planting - Provide all Information Below

Continued Certification of Established Fields - Provide Only Kind, Variety, Field No(s).

Kind _________________________________ Variety ___________________________________ No. Acres ___________

Seed Class Planted ___________________ Class to Produce __________________ Seedstock Source __________________

Seedstock Lot Number ______________ Field Number _____________________ Date Planted _______________________

Previous Crop and Variety Grown on Land _____________________ Distance from Other Turf Grass _______ Feet ______

Land Fumigation:	Yes _______	No ________

Material Applied _______________________________________________ Rate ___________________________

Date Applied ___________________________________ Fumigated by Applicant:	Yes _______ No _______

Custom Applicator: Name _______________________________________________________________________

Other Cultural Practices Conducted ______________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

I hereby apply for membership in the Southern Seed Certification Association for the current year and for inspection of the crop listed on this application. I understand and agree to abide by the Rules and Regulations of the SSCA relative to certification of the crop listed above. Also, I confirm that the entire acreage listed above was planted with seed represented by tags and purchase invoice submitted with this application.

FEES SUBMITTED (See Back)

Membership	$ _______________	* Planted an eligible class of certified seed on eligible land.

Acreage	$ _______________	* Thoroughly cleaned all equipment involved in planting.

Total	$ _______________	* Provided adequate isolation distance.

Make check payable to:

Southern Seed Certification Association, Inc.	________________________________________

P.O. Box 2619	Signature of Applicant

Auburn, AL 36831	_________________________________________

Phone (334)821-7400 (334)844-4995 Fax (334)844-4901)	Print Name

SUBMIT THE FOLLOWING WITH THIS APPLICATION:

New Planting:

1.	An invoice showing crop, variety, class, lot number and quantity of seed stock purchased

2.	A tag from each lot

3.	An invoice showing fumigation material, rate applied and size of area fumigate.

4.	Fees

Continued Certification of Established Fields:

1.	Completed application

2.	Fees

ANNUAL FEE SCHEDULE

Membership	$ 50.00

Application Fee:	$250.00

Acreage:	$ 50.00 per acre or part thereof for first 20 acres, $10.00 per acre for each additional acre or part thereof.

FINAL DATE FOR FILING APPLICATIONS

New fields:	30 days prior to planting if planting date can be established - but no later than date planted.

Continued Certification of established fields: February 1st each year.