NMDA ADJOINING LAND USE STATEMENT
To be completed by the person/business using land adjoining a certified organic farm.
It is the responsibility of the Certified Organic producer (not their neighbors) to maintain
the organic integrity of the farm. However, this form may be used to provide information from
neighbors when their land use practices might affect a Certified Organic farm, especially in
situations where a suitable buffer does not exist.
NAME OF ORGANIC FARMER/FARM
NAME OF ADJOINING LAND USER
PHONE/CONTACT
DESCRIPTION OF ADJOINING LAND USE (farm, ranch, grazing, industry, etc)
Adjoining Land User’s Statement
I,
Am aware of the certified organic status of the above named farm. I will make reasonable
efforts to conduct my land use practices in a way that does not pose a threat its certified
status, and I will notify them if an activity should occur on my land that may affect their organic
status.
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Signature
DOC C103 version k – Eff. date 2/1/13
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Date