HomeMy WebLinkAboutDL-22-Cert-of-Ownership-Movement-ADA
__________________________________ __________________________________
__________________________________ __________________________________
__________________________________ __________________________________
__________________________________ __________________________________
__________________________________ __________________________________
__________________________________ __________________________________
__________________________________ __________________________________
__________________________________ __________________________________
08/16
DL-22
08/16 CERTIFICATE OF OWNERSHIP/MOVEMENT
OF AGRICULTURAL COMMODITIES
Quality Assurance Division / Commodities Branch
This certificate is required if you sell any amount of an agricultural product that is to be marketed for
commercial purposes; or transport agricultural commodities with a weight greater than 200 pounds or
with a value of $100 or more.
OWNER GROWER SELLER: BUYER RECEIVER:
Name Name
Residence Street Address Street Address
City, State, Zip Code City, State, Zip Code
Phone No. Transport Vehicle License No. Phone No.
Quantity Product Description Price/unit
(optional)
Amount
(optional)
TOTAL AMOUNT DUE (OPTIONAL)
ORIGIN OF PRODUCT(S) - Name of Farm Owner and Physical Address (or TMK):
The information above is factual and correct to the best of my knowledge.
Print Name (Seller) Signature (Seller) Date
Print Name (Buyer) Signature (Buyer) Date
Two copies of this certificate must accompany the shipment and one copy is to be retained by the person
completing the certificate. False information or failure to comply may result in criminal prosecution as
provided in Chapter 145, Part II Hawaii Revised Statutes.
H
e
r
e
Cu
t
DL-22
CERTIFICATE OF OWNERSHIP/MOVEMENT
OF AGRICULTURAL COMMODITIES
Quality Assurance Division / Commodities Branch
This certificate is required if you sell any amount of an agricultural product that is to be marketed for
commercial purposes; or transport agricultural commodities with a weight greater than 200 pounds or
with a value of $100 or more.
OWNER GROWER SELLER: BUYER RECEIVER:
Name Name
Residence Street Address Street Address
City, State, Zip Code City, State, Zip Code
Phone No. Transport Vehicle License No. Phone No.
Quantity Product Description Price/unit
(optional)
Amount
(optional)
TOTAL AMOUNT DUE (OPTIONAL)
ORIGIN OF PRODUCT(S) - Name of Farm Owner and Physical Address (or TMK):
The information above is factual and correct to the best of my knowledge.
Print Name (Seller) Signature (Seller) Date
Print Name (Buyer) Signature (Buyer) Date
Two copies of this certificate must accompany the shipment and one copy is to be retained by the person
completing the certificate. False information or failure to comply may result in criminal prosecution as
provided in Chapter 145, Part II Hawaii Revised Statutes.