Form 925 Seed Analysis Certificate

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0579-0124. The time required to complete this collection is estimated to average .5 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.					FORM APPROVED OMB NO. 0579-0124
SEED ANALYSIS CERTIFICATE (For Canadian-grown seed destined for the United States.)				CERTIFICATE NUMBER      
1. NAME AND ADDRESS OF SENDER      				2. DATE ISSUED      
     
     				3. LABORATORY NUMBER      
     
SENDER’S INFORMATION (The information is that of the sender and not of the laboratory.)
4. ORIGIN      	5. KIND      			6. VARIETY      
7. SCIENTIFIC NAME      	8. LOT DESIGNATION      			9. SIZE OF LOT      
10. TREATMENT      				11. SAMPLE TAKEN BY      
12. OTHER INFORMATION      
LABORATORY DETERMINATION (To be used for labeling)
13. COMMON NAME(S) OF KINDS IN EXCESS OF 5% OF THE WHOLE (as recognized in Federal Seed Act regulations)      		14. SCIENTIFIC NAME(S)      
     		     
     		     
     		     
     		     
15. INDICATE IF SEED IS, OR WILL BE: Pelleted Coated Treated (Indicate labeling)
16. NOXIOUS WEED SEEDS BASED ON EXAMINATION OF       GRAMS
17. SCIENTIFIC NAME AND NUMBER OF EACH KIND OF NOXIOUS WEED      
18. “X” ONE I certify that this lot meets the noxious weed requirements of the Federal Seed Act. OR This lot contains noxious weeds beyond tolerance and may be imported into the United States only if consigned to an approved facility for cleaning.
19. NAME AND ADDRESS OF ISSUING LABORATORY      			20. NAME AND TITLE OF AUTHORIZING OFFICIAL      
     
     			21. SIGNATURE      
     

PPQ FORM 925 Previous versions are usable.

(FEB 2008)