Fillable STATE OF CONNECTICUT DEPARTMENT OF AGRICULTURE Applications, supporting (State of Connecticut/Department of Administrative Services)

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STATE OF CONNECTICUT DEPARTMENT OF AGRICULTURE Applications, supporting (State of Connecticut/Department of Administrative Services)

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1
STATE OF CONNECTICUT
DEPARTMENT OF AGRICULTURE
Office of the Commissioner
Bryan Hurlburt
Commissioner
860-713-2502
agr.hemp@ct.gov
Outdoor Field Planting Report
(rev. 6.26.19)
Complete the following table for Field Plot IDs:
NOTE: The Grower Plot ID MUST match the ID listed in your applications or Site Modification
Request.
DOAG
assigned
Plot ID
Grower
Plot ID
Hemp
Variety/
Strain
Planted
Seeds or
Trans-
plants
Area
Planted
(acres)
Primary
Intended
Purpose of
Crop (Grain,
Fiber, Floral,
Transplants)
Date
Planted
Expected
Harvest
Date
Check if
this is a
replant
Check if
NO
Planting
will occur
2. Do you intend to plant additional hemp at this address this y
ear ☐ Yes ☐
No
If “Yes”,
explain:
______________________________________________________________________________
License Holder: Grower License#:
Name of Signing Authority (if Business):
Email: Phone#:
Applications, supporting documents and payments will only be accepted through the
DOAG E-License portal. Paper applications will not be accepted.
This form is due for each and every plot approved on your application and any subsequent Site
Modification Requests. Use separate forms for different addresses. This form is due within 15 days
following the first day of each planting. If you will NOT plant at a licensed Plot, report of a “NO
Planting” is due by July 31.
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Save
2
3. If you only planted a portion of the licensed plot(s), attach an updated version of the map for this
address. Include the following new information on the map.
Circle only the area planted in each field
If not planting in a licensed field plot, mark an “X” through the field where hemp will NOT be
planted. Also, remember to write the Grower Plot ID for this no-plant field in the table on
Question (2) and mark the “No Planting” column.
By signing my name below, I attest that I am the license holder or the signing authority for the
license holder, and that this information is accurate and complete. I understand that giving a false
statement is punishable by law under section 53a-157b of the Connecticut General Statutes.
Signature: ______________________________________________ Date: ___________________
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STATE OF CONNECTICUT DEPARTMENT OF AGRICULTURE Applications, supporting (State of ConnecticutDepartment of Administrative Services)

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Completed 20 July 2020

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