A certificate of intent as provided for in section 2 of the enrichment law shall be in one of the two following forms:
CERTIFICATE OF INTENT
In compliance with the provisions of section 2 of the Kansas enrichment law, it is hereby certified by
(Purchaser)
that all unenriched flour purchased from
(Seller)
after
will be used only in the manufacture,
(Date)
mixing, or compounding of white bread or rolls enriched to meet the requirements of the Kansas enrichment act or of products other than flour, white bread, or rolls.
This certificate shall be cancelled only by written notice by the purchaser.
(Date) (Agent of purchaser)
Kan. Admin. Regs. § 28-22-4