Because numerous producer affidavits or certification statements are now required by markets of their consignors, i.e., the BSE mammalian feed rule, country of origin labeling, compliance with drug residue requirements and a statement on residue repeat violators, the Livestock Marketing Association (LMA) has combined all these necessary producer certification requirements into one comprehensive "Consignor/Livestock Owner's Certificate."

Please read and complete the form below. Once completed, print the form off and sign it. Remit the form to Central Wyoming Livestock in person or via mail at PO Box 1810, Glenrock, WY 82637.

The undersigned consignor/livestock owner:

1. Delivers livestock to be sold at public auction in accordance with this market's usual customs and practives;
2. Represents that there are no liens on any of the livestock except as the undersigned has disclosed to the market;
3. Certifies that to the best of his/her knowledge, none of the livestock are adulterated within the meaning of the Federal Food, Drug and Cosmetic Act (e.g., none of them has been fed any feed derived from mammalian tissues as prohibited by 21 C.F.R. 589.2000 nor are they contaminated with foreign materials nor do they have illegal levels of drug residues);
4. Certifies that neither the undersigned nor the person(s) from whom the consignor purchased the livestock are on the USDA/FSIS active list of repeat violators as havingmore than one residue violation in the past 12 months or if they are on the USDA/FSIS list taht the consignor has identified the animals being sold that come from the person whose name appears on the USDA/FSIS list;
5. Attests 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 USA origin and that should the origin of the livestock become other than that described above, the undersigned will notify the buyer/agent when this occurs; and
6. Acknowledges that the consignor of livestock is responsible for payment of any veterinarian bills and disposal charges that arise if any of his/her livestock become non-ambulatory while in the market.

This certificate/declaration/affidavit shall remain in effect until the undersigned delivers written notice of revocation to the market.