Texas Department of Agriculture s3

Texas Department of Agriculture Family Land Heritage

Certificate Order Form

Please Print or Type:

Name of Farm/Ranch: ______

County the Farm/Ranch is located in:______

Year Honored:______Year Founded:______

Name:______

Address: ______

City: ______State:______Zip:______

Phone Number: (______) ______E-mail:______

How many Family Land Heritage certificates do you want? ______X $30 each

(TDA reserves the right to limit quantities subject to certificate availability)

Total $______

Please make check or money order payable to the Texas Department of Agriculture.

We cannot accept credit cards as a form of payment.

Mail this completed form and check or money order to:

Texas Department of Agriculture

Family Land Heritage Program

P.O. Box 12847

Austin, Texas 78711

If you have any questions, contact Justin Rand, Family Land Heritage Program,

at (512) 463-9885 or .