Form PPQ 651 PPQ 651 Application for Plum Pox Compensation

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control
number. The valid OMB control number for this information collection is 0579-0159. The time required to complete this information collection is estimated to
average .16 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information.
U.S. DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
PLANT PROTECTION AND QUARANTINE

APPLICATION FOR PLUM POX COMPENSATION
1. NAME OF APPLICANT

2. ADDRESS OF APPLICANT (Include Zip Code)

3. TAX ID NO.

4. LOCATION OF THE AFFECTED ORCHARD BLOCK(S) OR NURSERY

5. DATE DESTRUCTION ORDER OR EMERGENCY ACTION NOTIFICATION (EAN)
ISSUED.

6. DATE(S) ACTUAL DESTRUCTION OF ORCHARD OR NURSERY STOCK
OCCURRED.

NOTE: When submitting this application, you must provide copies of the destruction order or EAN and its
accompanying inventory describing the trees or nursery stock subject to the destruction order or EAN.
7. FOR ORCHARDS: AGE OF ORCHARD AND EXACT ACREAGE DESTROYED (to 1/10th of an acre).
IF THE ORCHARD CONTAINED TREES OF DIFFERENT AGES, LIST THE EXACT ACREAGE OF EACH AGE POPULATION IN THE ORCHARD.

8. FOR NURSERIES: NUMBER (by age and species) OF TREES IN THE NURSERY THAT WERE SUBJECT TO THE EMERGENCY ACTION NOTIFICATION.

I certify that all statements and entries I have made on this document are true and accurate to the best of my
knowledge and belief. I understand that any intentional false statement or misrepresentation made on this
document is a violation of law and punishable by a fine of not more than $10,000, or imprisonment of not more
than 5 years, or both (18 U.S.C. 1001).
APPLICANT'S SIGNATURE

PPQ FORM 651-R
SEP 2006

DATE