PPQ 925 Seed Analysis Certificate

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not 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 informatiocollection 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
EXP DATE: XX/XX/XX

CERTIFICATE NUMBER

SEED ANALYSIS CERTIFICATE
(For Canadian-grown seed destined for the United States)
1. NAME AND ADDRESS OF SENDER

2. DATE ISSUED

3. LABORATORY NUMBER

4. ORIGIN

SENDER’S INFORMATION (The information is that of the sender and not of the laboratory.)
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 14. SCIENTIFIC NAME(S)
(as recognized in Federal Seed Act regulations)

15. INDICATE IF SEED IS, OR WILL BE:

Pelleted

Coated

16. NOXIOUS WEED SEEDS BASED ON EXAMINATION OF

Treated (Indicate labeling)
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
(MAY 2013)