(6) a statement in substantially the following form: State of Alaska)
) ss:
______ Judicial District )
I, __________________________________, as the owner or permit holder responsible for the dairy farm operation identified above, hereby certify as follows:
(A) that no animals on the above farm are currently being treated with recombinant bovine somatotropin (rBST), also known as recombinant bovine growth hormone (rBGH);(B) that no animals on the above farm have received rBST treatments within the past 30 days;(C) that I will provide written notice to the buyer of my milk at least thirty (30) days in advance if I intend to use rBST on my dairy cattle; and(D) that I will not sell milk from animals added to my herd if those animals may have received rBST treatment within the previous 30 days. I declare, under oath, that the above statement is true and correct to the best of my knowledge.
Producer Signature ______
Subscribed and sworn to or affirmed before me at ______ on ________________ .
Notary Public
My Commission Expires