Fillable MDAR - Industrial Hemp Harvest Request

Fill Online, Printable, Fillable, Blank MDAR - Industrial Hemp Harvest Request Form

Use Fill to complete blank online COMMONWEALTH OF MASSACHUSETTS (MA) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

MDAR - Industrial Hemp Harvest Request

On average this form takes 16 minutes to complete

The MDAR - Industrial Hemp Harvest Request form is 2 pages long and contains:

  • 0 signatures
  • 33 check-boxes
  • 47 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Commonwealth of Massachusetts

BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Last update: 11 March 2019
T
HE
C
OMMONWEALTH
O
F
M
ASSACHUSETTS
EXECUTIVE OFFICE OF ENERGY AND ENVIRONMENTAL AFFAIRS
Department of Agricultural Resources
251 Causeway Street, Suite 500, Boston, MA 02114
617-626-1700 fax: 617-626-1850 www.mass.gov/agr
Industrial Hemp Harvest Report
All Harvest Reports must be submitted at least fourteen (14) days before harvest
Directions
• Complete all parts of the following form and submit to the Department no later than fourteen (14) days
prior to harvest or destruction to allow time to schedule sample testing.
• Following the submission of this form, the Department will contact you to schedule an appointment to
collect samples. Harvest may not begin until samples have been collected.
• The licensee or a previously designated authorized signatory must be physically present during sampling.
• Crop must be harvested within ten (10) days after sampling has taken place.
• If harvesting prior to receiving the sample results, you MUST hold on to all harvested crop material which
may not be comingled with other varieties nor extracted until a Certificate is issued from the Department.
Mail to:
Massachusetts Department of Agricultural Resources Hemp Program
251 Causeway Street
Boston, MA 02114
Attn: Sarah Grubin
or email: sarah.grubin@state.ma.us
Please type or print clearly (incomplete or illegible forms will be returned).
License Holder Information
Name of License Holder:
MDAR License no:
Mailing Address:
Primary Phone:
☐
cell
☐
home
☐
office
Email:
MA Industrial Hemp Harvest Report
Page 2 of 2
P
lease submit a separate page for each location
Harvest Area Detail
Please provide the following information for each site to be harvested. If there is more than one licensed growing area to be harvested, please
fill out additional Harvest/Destruction Forms for each.
Site Name:
Physical Address:
City: State: Zip Code:
Latitude:
Longitude:
Harvest Information
Grow Area Name Variety/Strain Planting Date Harvest Date Harvest Area
Partial or
Complete
Harvest?
acres
ft
2
Partial
Complete
acres
ft
2
Partial
Complete
acres
ft
2
Partial
Complete
acres
ft
2
Partial
Complete
acres
ft
2
Partial
Complete
acres
ft
2
Partial
Complete
acres
ft
2
Partial
Complete
Additional Site Details:
Do you have any other Industrial Hemp remaining on your property?
Yes
No
Note: If you have Industrial Hemp remaining on your property that has not yet been tested, and is not being
harvested at this time you will need to submit another Harvest Report form at least fourteen (14) days prior to
harvest of that crop
Official Use Only
Date received:___________________________
Reviewed by:___________________________________
Sampling scheduled:
☐
YES
☐
NO
Sampling Date:_______________________________
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

MDAR - Industrial Hemp Harvest Request

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 11 May 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document