2017 CROP GROWER'S IDENTITY PRESERVED NON
2017 CROP GROWER’S IDENTITY PRESERVED NON-GMO CORN CERTIFICATE Granite City, IL
I, ___________________________________________ (grower) certify the grain being delivered to H & B Specialties, Inc. (grain elevator) and being sold to H & B Specialties, Inc. is a NON-GMO corn variety. Please circle varieties being delivered below: Ag Venture 7844
Agrigold 6499
6501
Beck’s 5337 5828 6076 6175 6225
Burrus 4J90
Channel 214-12
DeKalb 61-52 62-06
eMerge 731
FS Seeds 62B00
Gateway 6158
Pioneer 1602 1197
Spectrum 6515
Sun Prairie 2708 2818
Wyffels W7800
LG Seeds 5618 Stewart S600 S750
I certify to the best of my knowledge that: 1) The NON-GMO corn was planted and harvested in such a manner to preserve the IDENTITY of the NON-GMO corn. 2) The CARGO has not been treated with any CHEMICAL after its harvest. 3) I confirmed that all of the equipment used for the NON-GMO corn including storage, combine, auger, and conveyors were clean and empty before handling this NON-GMO corn. 4) Samples will be taken from each truck when the corn is delivered to the above named elevator. 5) I will provide a copy of the “seed corn invoice” for proof of purchase if requested. 6) If it is found that corn I have delivered is knowingly contaminated with GENETICALLY MODIFIED MATERIAL, I will be excluded from this program and will be subject to exclusion from any other programs and I will lose or refund any premiums paid to me for such corn. 7) I have followed the grower policies & procedures as instructed by H&B Specialties, Inc.
X__________________________________
Receiving Elevator: H & B Specialties, Inc.
Grower’s Signature
Date: ______________________________
Quantity (bushels): ___________________________
I, ___________________________________________ (grower) certify the grain being delivered to H & B Specialties, Inc. (grain elevator) and being sold to H & B Specialties, Inc. is a NON-GMO corn variety. Please circle varieties being delivered below: Ag Venture 7844
Agrigold 6499
6501
Beck’s 5337 5828 6076 6175 6225
Burrus 4J90
Channel 214-12
DeKalb 61-52 62-06
eMerge 731
FS Seeds 62B00
Gateway 6158
Pioneer 1602 1197
Spectrum 6515
Sun Prairie 2708 2818
Wyffels W7800
LG Seeds 5618 Stewart S600 S750
I certify to the best of my knowledge that: 1) The NON-GMO corn was planted and harvested in such a manner to preserve the IDENTITY of the NON-GMO corn. 2) The CARGO has not been treated with any CHEMICAL after its harvest. 3) I confirmed that all of the equipment used for the NON-GMO corn including storage, combine, auger, and conveyors were clean and empty before handling this NON-GMO corn. 4) Samples will be taken from each truck when the corn is delivered to the above named elevator. 5) I will provide a copy of the “seed corn invoice” for proof of purchase if requested. 6) If it is found that corn I have delivered is knowingly contaminated with GENETICALLY MODIFIED MATERIAL, I will be excluded from this program and will be subject to exclusion from any other programs and I will lose or refund any premiums paid to me for such corn. 7) I have followed the grower policies & procedures as instructed by H&B Specialties, Inc.
X__________________________________
Receiving Elevator: H & B Specialties, Inc.
Grower’s Signature
Date: ______________________________
Quantity (bushels): ___________________________
