Texas Form Ror 600 – Fill Out and Use This PDF

SECTION C

1PERSON TO CONTACT FOR LICENSE-RELATED MATTERS

Mr.		Mrs.	First Name	M.I.	Last Name
Ms.		___
Title				Primary Phone
				(	)	-		Ext.
Secondary Phone (optional)				Fax (optional)
(	)	-	Ext.	(	)	-		Ext.
E-mail (optional)				Would you prefer to be contacted by E-mail?
				Yes				No
2MAILING ADDRESS
Address
City							State		Zip

SECTION D

1FACILITY INFORMATION

Facility Name

2PHYSICAL ADDRESS OF LOCATION OF LICENSEE, LICENSED ACTIVITIES or EQUIPMENT

Address (No P.O. Box)

City	State	Zip	County

Directions to Physical Location if address above is difficult to find

SECTION E

1OUT-OF-STATE APPLICANTS ONLY

An applicant for an Organic Certification whose principal place of business is situated outside the State of Texas must appoint and designate a resident citizen of Texas as said applicant's resident agent with Texas. If the address provided in Section B is out of state, resident agent information is REQUIRED.

Who do you wish to designate as resident agent?

The Texas Secretary of State Other (list below)

Resident Agent Name

Resident Agent Address

City	Zip	Business Phone
		(	)	-

SECTION J

1DISTRIBUTOR

Broker/Trader (check all that apply)

Food Products

Feed Products

Fiber Products

Warehousing/Storage (check all that apply)

Food Products

Feed Products

Fiber Products

Packing/Grading/Sizing (check all that apply)

Food Products

Feed Products

SECTION K

1PAYMENT

See instructions for applicable fees.

CERTIFICATION IS NOT VALID UNTIL APPROVED BY TDA

Method of Payment (payable to Texas Department of Agriculture)
Check # ________		Cashier's Check # ________		Money Order # ________
Amount remitted			Mail to: Texas Department of Agriculture
			P.O. Box 12076, Austin, TX 78711-2076
TDA USE ONLY	Receipt No.		Date Receipt Issued

SECTION L

1PREVIOUS CERTIFICATIONS

Have you previously applied for organic certification with another certifier?	Yes	No
If Yes:

1.List the name(s) of any organic certifying agent(s) to which application has previously been made:

_________________________________________________________________________________________

2.List year(s) when application(s) was submitted: ______________________________________________

3. Outcome of the application(s) submission:	Approved	Denied	Withdrawn
If applicable, attach:

A.Copy of any certification conditions, notification of noncompliance or denial of certification issued to the applicant

B.Description of actions taken to correct the noncompliance or to meet certification conditions

C.Evidence of such correction

SECTION M

1SIGNATURE

The applicant, by and through their personal or agent's signature below (1) certifies that all information provided in connection with this application at any time is true and correct to the best of the applicant's knowledge; (2) acknowledges that any misrepresentation or false statement made by the applicant, or an authorized agent of the applicant, in connection with this application, whether intentional or not, will constitute grounds for denial, revocation, or non-renewal of any license issued pursuant to this application and/or assessment of monetary administrative penalties; and (3) if applying as an individual, further acknowledges that this application may be denied and that any license issued pursuant to this application may be suspended, revoked, or denied renewal due to delinquency in payment of a guaranteed student loan and that any license issued pursuant to this application may be suspended or denied renewal for failure to pay child support. Applicant similarly certifies that such farm or handler has not produced or handled any agricultural product sold or labeled as organically produced except in accordance wi employee) of the applicant, the person signing certifies that he or she is authorized to make the preceding certifications on behalf of the applicant.

Applicant Name	Title
Applicant Signature	Date	/	/
	month	day	year

SECTION N

1CHECKLIST

Please use this checklist to ensure you are sending all of the necessary information and documents. Organic standards require you to keep a copy of your application and all supporting documentation for your files.

Organic Certification Application

Fees (see instructions for assistance with calculating the correct fee)

All applicable supporting documentation:

Land Producer - ROR-607 Producer Organic System Plan

ROR-621 Previous Land Owner/Manager Affidavit for Organic Land Certification (if applicable) ROR-622 Seed and Planting Stock Disclosure (if applicable)

Livestock Producer - ROR-603 Livestock Organic System Plan

ROR-623 Organic Livestock Dry Matter Worksheet (if applicable)

ROR-624 Organic Livestock Outdoor Access Calendar

Processor (Food and Feed) - ROR-606 Processor (Food and Feed) Organic System Plan Processor (Fiber) - ROR-604 Processor (Fiber) Organic System Plan

Distributor - ROR-602 Distributor Organic System Plan Retailer - ROR-608 Retailer Organic System Plan

Please note that an incomplete application will result in processing delays.