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pdfForm Approved OMB NO 0581-0055
USDA, Agricultural Marketing Service
Science and Technology Program
PLANT VARIETY PROTECTION OFFICE
1400 Independence Avenue, S.W.
Room 4512, South Building, Mail Stop 0274
Washington, D.C. 20250
Office: (202) 260-8983 Fax: (202) 260-8976
Email: PVPOmail@ams.usda.gov
RECORDATION FORM
Use this form to request a revision on a PVP original application(s) which require(s) a fee of $41 per application.
If an assignment is being requested, attach assignment document to this form.
1. Current Owner(s) of Record
2. Type of Recordation (check all that apply)
(See attached appendix for definition and instructions)
Name:
___ Change Name of Owner(s)
___ Change Address of Owner(s)
___ Change Name of Representative
___ Change Address of Representative
___ Assignment (transfer of authority or ownership)
___ Security Interest, License, Grant, Conveyance
___ Merger
___ Revocation of Assignment, Security, Interest, License, Grant
___ Change Variety Name
___ Other (specify)
Address:
Phone:
Fax:
Email:
3. New Owner(s)
4. New Representative/Agent
Name:
Name:
Address:
Address:
Phone:
Fax:
Phone:
Email:
5.
Fax:
Email:
The PVP Number(s), Crop kind(s), Variety name(s) for the affected application. Attach list if more space is needed.
PV number
Crop kind
Variety Name
6. Total number of applications involved :
PV number
Crop kind
Variety name
multiply by $41 per application(s). Total Amount $
Fees must be paid by U.S. funds either by credit card or checks made payable to the: “Treasurer of the United States.”
7. Statement and Signature: To the best of my knowledge and belief, the foregoing information is true and correct and any attached
copy is a true copy of the original document.
Print Name
Signature
ST-473 (Exp. 12/31/2021) Designed by the Plant Variety Protection Office
Date
Form Approved OMB NO 0581-0055
Appendix (Instructions)
TERMS and DEFINITION
Recordation:
To record changes requested by the representative or agent of the
applicant.
Assignment:
When an owner transfers his authority rights from one person to
another to handle his business, crop kind, variety, seeds, and sale of
seeds, or the transfer of ownership from one company to another.
Security Interest:
Property interest used as collateral.
License:
To give permission to exercise legal rights or privileges from one owner
to another.
Grant:
A gift of legal rights or privileges from one owner to another.
Conveyance:
The transfer of personal property from one owner to another.
Revocation:
Cancellation or annulment of a privilege, title or authorization.
Revocation of assignment (transfer of authority) agreement, including security
interest.
Revocation of license (authority to use or sell seeds).
Revocation of grant privileges.
Merger:
A legal combination of two or more companies to form a new company.
RECORDATION EXPLANATION and FEE REQUIREMENTS
Recordation is a revision of the original application filed with the Plant Variety Protection Office and requires an additional fee payment of $41 per
application. All recordation transactions such as the transfer of authority, transfer of ownership, or change of owner’s name requires an assignment
document with an authorized signature(s) and should be attached to this form.
Recordation fee(s) can be calculated by multiplying the total number of application(s) by $41.
FEE PAYMENT OPTIONS
Check
All fees must be paid by US funds. Make check payable to the “Treasurer of the United States.” Include the PV number(s) on the check.
Credit card
Attach the “Request for Service (ST-471) form” for all credit card transactions. Enter all credit card information, including the credit card type
(Visa/MasterCard/American Express), the credit card number, the security code number, name and address of agency, cardholder’s name, telephone
number and email address. Include the PV number(s) for each application, crop kind and variety name(s).
Money Transfer
Any domestic or foreign company requesting a money transfer must be affiliated with a USA bank and must provide the following information: A ninedigit routing number, bank account number, check number, account type (saving or checking) and payment amount. Include the PV number(s) for each
application. Plant Variety Protection Office cannot process credit card payments or money transfer without an authorized signature.
BURDEN STATEMENT
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 0581-0055. The time required
to complete this information 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.
USDA’s Nondiscrimination Statement
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices,
and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin,
religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from
a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA
(not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.
Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign
Language, etc.) should contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal
Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.
To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at
http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the
information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by:
1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 202509410;
2)
fax: (202) 690-7442; or
3)
email: program.intake@usda.gov.
USDA is an equal opportunity provider, employer, and lender.
ST-473 (Exp. 12/31/2021) Designed by the Plant Variety Protection Office
File Type | application/pdf |
File Modified | 2018-10-31 |
File Created | 2018-10-31 |