OHIO DEPARTMENT OF AGRICULTURE

Division of Plant Industry - Grain & Seed Section

8995 East Main Street

Reynoldsburg, OH  43068-3399

(614) 728-6410

DIVISION:

Web FORM:

Last Revised:

FORM EXPIRES:

PLNT-GS

4203-002

07/10/2003

12/31/2003

FOR DIVISION USE ONLY

Certificate # Issued:_____________

Certification Expiration:___________