Variety Ownership Declaration

Contractor Authorization

Variety Ownership DeclarationRelease of OSCS Production Data

Oregon Seed Certification Service31 Crop Science Bldg., OSUph 541-737-4513

Corvallis, OR 97331-3003fax

Date submitted

Variety name Crop kind

Information to be completed and signed by the variety applicant

Person / CompanyPhone

Street / POFax

CityE-mail

State / ProvinceRepresentative[1]

Postal CodeSignature [2]

Information to be completed and signed by the breeder if not the same as the applicant listed above

Person / CompanyPhone

Street / POFax

CityE-mail

State / ProvinceRepresentative 1

Postal CodeSignature2

Contractor Authorization and Release of OSCS Production Data

List the companies, or individuals, authorized by the variety owner 5 to contract certified production of this variety in Oregon, beginning with the primary licensee if applicable. Only those contractors or licensees authorized by the variety owner will be listed by OSCS for certification in Oregon. The option to authorize release of OSCS production data, as designated below, may be granted by the licensee or contractor if signed by their representative.

Licensee Representative 1

OSCS data may be released to: (no reply)No oneOwner onlyApplicant onlyBreeder onlyOwner and ApplicantOwner and BreederApplicant and Breeder(see attachment)Signature [3]

Exclusions [4] NoneGrower nameField numberField locationGrower name and field numberGrower, field number and location(see attachment)

Contractor Representative 1

OSCS data may be released to: (no reply)No oneOwner onlyApplicant onlyBreeder onlyLicensee onlyOwner and ApplicantOwner and BreederOwner and LicenseeApplicant and BreederApplicant and LicenseeBreeder and Licensee(see attachment)Signature 3

Exclusions 4 NoneGrower nameField numberField locationGrower name and field numberGrower, field number and location(see attachment)

Contractor Representative 1

OSCS data may be released to: (no reply)No oneOwner onlyApplicant onlyBreeder onlyLicensee onlyOwner and ApplicantOwner and BreederOwner and LicenseeApplicant and BreederApplicant and LicenseeBreeder and Licensee(see attachment)Signature 3

Exclusions 4 NoneGrower nameField numberField locationGrower name and field numberGrower, field number and location (see attachment)

Information to be completed and signed by the variety owner[5] if different than the variety applicant

Person / CompanyPhone

Street / POFax

CityE-mail

State / ProvinceRepresentative 1

Postal CodeSignature5

VOD-080315

[1]Name and title within the company of the person providing this information if a company name is listed as the Applicant, Breeder, Owner, Licensee or Contractor of this variety.

[2] A signature is required to signify agreement with the statements listed on the submitted variety application.

[3] This authorization for the release of OSCS data is valid only if signed by a representative for the licensee or contractor.

[4]List any exclusions related to the release of OSCS production data (e.g., withhold grower name, field number, or production generation).

[5] The owner is the person or company that holds all rights, title and interest in this variety. Signature required for licensee and contractor designations.