(from kashrus/kk-medi-terumos.htm">http://www.star-k.org/kashrus/kk-medi-terumos.htm, used with permission)

Post this document in a conspicuous place.

1. Break or cut off more than one hundredth of the food and set it aside (for teruma and terumat ma'aser).
2. Say the following (either in Hebrew or English):
   
   
   
   Yoteir me'echad me'me'a she'yeish kahn harei hu teruma gedola be'tzad tzefono. Oto echad me'me'a she'yeish kahn ve'od tish'a chalakim k'moto be'tzad tzefono shel ha'peirot harei hu ma'aser rishon. Oto echad me'me'a she'asitiv ma'aser rishon asuy terumat ma'aser, uma'aser sheini b'dromo, u'mechulal hu ve'chumsho al peruta be'matbei'a sh'yichidita lechilul ma'aser sheini ve'revai. Ve'im tzarich ma'aser ani ye'hei ma'aser ani bi'dromo. Im hu revai ye'hei mechulal hu ve'chumsho al peruta be'matbei'a she'yichidita le'chilul ma'aser sheini ve'revai.
   
   (Im ma'aser minim harbei tzarich le'hosif) “kol min al mino.”
   
   
   Translation
   (If there is a food of one type that requires separation) Whatever is MORE than one hundredth of this food shall be teruma on the north side of the piece that I have set aside. The one hundredth that is left in the piece I have set aside plus nine other pieces the same size on the north side of the food shall be ma'aser rishon. That same one hundredth in the piece I set aside that I have made ma'aser shall be terumat ma'aser.
   Furthermore, I am proclaiming ma'aser sheini to be in effect on the south side of the food, and I am redeeming it and its fifth on a pruta (smallest amount of money recognized by the Torah for most purposes) of this coin which I have in front of me. If this food needs ma'aser ani, the ma'aser ani shall take effect on the south side of the food.
   If this food is subject to the laws of neta revai then it and its fifth shall be redeemed on a pruta of this coin that I have in front of me.
   
   If there is a food of more than one type, add each type of food for its type.
    
3. Wrap the broken or cut-off piece in plastic and discard.
4. The coin--dime or coin of greater value--must eventually be disposed of in such a manner that it will not be used.
5. The food may now be eaten.

 
If you do not want to say the long version, you may say this shorter version, after having separated a piece larger than 1\% of the total food:
All separations and redemptions shall take effect as is specified in this Star-K document outlining the Procedure for Separating Terumot and Ma'asrot, Tithes and Redemptions, which I have in my possession.

Whether saying the long or short version, only a little over one hundredth of the food will not be permitted to eat; all the rest may be eaten. Even though the tithes constitute over one fifth of the food, one is permitted to eat most of the tithes oneself, even though he may not be a Cohen or a Levi. Under no circumstances will it suffice merely to break off a piece of the food and throw it away. The aforementioned instructions must be strictly followed. The laws of the tithes apply to everyone, including the Cohen and Levi.

You must say the blessing lehafrish trumot u'ma'asrot if you know the produce definitely needed to have teruma and ma'aser taken; it was definitely:

• Grown on Jewish-owned land in halachic Eretz Yisrael and
• Had not yet had teruma and ma'aser taken from it.

BUT you must not say the blessing if the produce might have:

• Not been grown on Jewish-owned land in halachic Eretz Yisrael, OR
• Already had teruma and ma'aser separated.