115 D Street
PO Box 97
Sheldon, IA 51201
712.324.3144 Phone
712.324.5222 Fax
Affidavit #____________
(For Internal office use only)
Continuous Affidavit/Declaration of Country of Origin of Livestock
Whereas an affidavit is deemed by USDA as an official record of Country of Origin,
I, ________________________________ (seller) attest through first-hand knowledge, normal business records, or producer affidavit(s) that all livestock referenced by this document or other communications specific to the transaction and transferred are of:
Please check which box/boxes apply.
A.
U.S. Origin (exclusively born and raised in the United States)
B.
Canadian Origin.
C.
Mexican Origin.
Should the origin of my livestock become other than that described above, I agree to notify the market/buyer/agent verbally and in writing when this occurs. This Affidavit/Declaration shall remain in effect until revoked in writing by the undersigned and is delivered to SFRL,
Inc. dba Sheldon Livestock, 115 D Street. PO Box 97, Sheldon, IA 51201
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Printed Name or Business/Farm/Ranch Name (if applicable)
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Signature
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Address/City/State/Zip
______________________
Date
Please mail to address above or fax to 712-324-5222.