Authorization of Agent

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This form is to be used as a template for the Plant Breeders' Rights authorization of agent. Contact information is required about the agent, applicant, and information about the variety. The form must be witnessed.

Please submit a separate assignment for each variety.

The following may serve as a standard form to be completed for the authorization of agent. Please note that the agent will be the main contact person for the office and has the ability to change the status of the application. For example, the agent has the ability to withdraw the application for PBR.

I/We hereby authorize

(name and address of agent)

To act, for all purposes of the Plant Breeders' Rights Act, on behalf of me/us as my/our agent, for the

(common name of species)

variety entitled (variety denomination)

Name and address of applicant (or person signing on behalf of applicant):

Signature

Date

Witness

Assignee

Date modified: