OREGON DEPARTMENT OF TRANSPORTATION COMMERCE AND COMPLIANCE DIVISION 3930 FAIRVIEW INDUSTRIAL DRIVE SE SALEM OR 97302-1166 PH (503) 378-5203 FAX (503) 378-8815

FARM CERTIFICATION APPLICATION

FARM NO.

DATE RECEIVED

NAME OF FARM (IF APPLICABLE) NAME OF FARMER (PRINT)

COUNTY/COUNTIES USDOT NUMBER FEIN OR TIN

FARM ADDRESS CITY STATE ZIP

MAILING ADDRESS (IF DIFFERENT) TELEPHONE NUMBER

1. OWN 2. RENT/LEASE

NAME TELEPHONE

ADDRESS CITY ST ZIP CODE

AGENCY USE ONLY

FORM 735-9670 (10-20)

VEHICLES TO BE REGISTERED UNDER FARM CERTIFICATIONPLATE NUMBER YEAR MAKE BODY STYLE VEHICLE IDENTIFICATION NUMBER REGISTRATION WEIGHT AXLE COUNT

I certify the information above and on any attachments is true and correct and all information given is made under the penalty for false certification (ORS 805.370). False certification is a Class A Misdemeanor. Violation may result in a fine of up to $6,250, a maximum jail sentence of one year or both. A Certified Farming operation shall immediately notify the Oregon Department of Transportation, Commerce and Compliance Division if there is any substantial change in the farming operation as defined in OAR 735-048-0000 (See instructions on reverse side of form). Faxed and electronic signatures are acceptable.

Before completing, see instructions on page 2. If more space is required, attach a separate sheet.

LIST THE TOTAL NUMBER OF ACRES YOU:

DATENAME (PLEASE PRINT OR TYPE)SIGNATURE

DO NOT LIST BY DOLLAR AMOUNT OR ACREAGE

APPLICANT INFORMATION

QUANTITYLIST THE TYPE AND QUANTITY OF AGRICULTURAL PRODUCTS PRODUCED ANNUALLY

LIST THE TYPE AND AMOUNT OF LIVESTOCK YOU CURRENTLY HAVE QUANTITY

LIST THE NAME, PHONE NUMBER, AND ADDRESS OF THE PERSON(S) YOU LEASE/RENT FROM

CERTIFICATION

Federal Employee Identification Number (FEIN) or Tax Identification Number (TIN). Must match the number used to complete USDOT # application.

INSTRUCTIONS FOR COMPLETION OF APPLICATION FOR FARM CERTIFICATION

Axle count: List the total number of axles, including the front steering axle on the truck/ tractor and any heavy permanently registered trailers that may be towed by this vehicle. (Do not include any drop or lift axles)

• Agricultural (hay, wheat, grass seed, mint oil, Christmas trees, fruits and vegetables: etc): List the quantity by pounds, CWT, gallons or tons. List Christmas trees as the total number of trees currently planted.

• Animal By-Product (eggs, milk, honey, wool, etc): List quantity by dozen, gallons or pounds. • Apiary: List the total number of beehives or colonies. • Horticulture (nursery stock, plants, shrubs, herbs, ornamental trees, sod: etc) List as pieces, pounds,

tons; use square feet produced annually for Sod. • Livestock (cattle, horses, hogs, sheep, oysters, worms etc): List the total head count by kind of animals

that you have at the present time, use pounds produced annually for oysters or worms. NOTE: Domestic animals such as dogs, cats and exotic birds such as Parrots or Parakeets are not classified as livestock and are not eligible farm commodities.

• Viticulture: List the total pounds or tons of wine grapes produced annually or the total number of plants you have at the present time.

NOTE: Commercial feedlots, horse boarding facilities, timber and lumber operations are not classified as farming operations and are not eligible for farm registration.

LIST COMMODITIES PRODUCED ANNUALLY BY WEIGHT LIST LIVESTOCK PRODUCED ANNUALLY BY HEAD COUNT

If you have any questions, Please contact the Farm Certification Unit Phone 503-378-5203 Fax 503-378-8815 Email Gr-mctdfarmunit@odot.state.or.us

Or visit us on the Web at:

A "substantial change" to a farming operation occurs when any of the following happens:

(a) The amount of land owned, leased or rented by the farmer listed for purposes of qualifying for farm registration decreases;

(b) The amount of agricultural commodities, products produced or livestock raised decreases to the point that they do not reasonably require the use of the vehicles registered under farm operation;

(c) The vehicle(s) ceases to be used on the one or more farms, orchards or ranches for which farm or proportional farm registration was applied for or ceases to be used for the purposes allowed under such registration; or

(d) The farming operation begins operating vehicles (other than pickup trucks) in combinations of four or more axles or which have a registered weight of over 26,000 pounds

NOTE: Motor Carriers (including farmers) that operate vehicles over 10,000 pounds Gross Vehicle Weight (GVW) are required to have a USDOT Number. This is a safety number issued by the Federal DOT office and required to be posted on the side of vehicles with a GVWR (Gross Vehicle Weight Rating) greater than 26,000 pounds, carry hazardous materials or passenger vehicles designed or used to transport more than 15 passengers, including the driver. A carrier will have only one USDOT Number, regardless of the number of vehicles the carrier operates. To obtain a USDOT number apply online at https://portal.fmcsa.dot.gov/UrsRegistrationWizard/. For questions regarding the online processes for obtaining a USDOT number, please contact the local Federal Motor Carrier Safety Administration (FMCSA) office in Salem at 503-399-5775 or call the FMCSA toll free at 1-800-832-5660.

https://www.oregontruckingonline.com/cf/MCAD/pubMetaEntry/index.cfm?fuseAction=forms&category=registration

https://www.oregon.gov/ODOT/MCT/Pages/FarmTrucking.aspx