P&SP 3500 Statement of Accounts Payable for Livestock - Special Re

OMB CONTROL NO. 0580-0015
U.S. DEPARTMENT OF AGRICULTURE
GRAIN INSPECTION, PACKERS AND
STOCKYARDS ADMINISTRATION
PACKERS AND STOCKYARDS PROGRAM

STATEMENT OF ACCOUNTS PAYABLE
FOR LIVESTOCK
SPECIAL REPORT

NOTE: If space provided in any item is not sufficient, attach additional sheets and make reference to the item number.

1. REGULATED ENTITY’S NAME AND ADDRESS (Street and No., City, State, and Zip Code)
Note: If registrant operates under a different name(s), list all names under which registrant operates.

2. As of: (Date) ____________________
3. SCHEDULE OF ACCOUNTS PAYABLE FOR LIVESTOCK
DATE PURCHASED

NAME OF SELLER

DOLLAR AMOUNT
DUE FOR
LIVESTOCK

AUGUST 2007

P&SP-3500

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3. SCHEDULE OF ACCOUNTS PAYABLE FOR LIVESTOCK (continued)
DATE PURCHASED

NAME OF SELLER

DOLLAR AMOUNT
DUE FOR
LIVESTOCK

4. TOTAL

DATE PAID

$

CERTIFICATION: I certify that this report has been prepared by me or under my direction and that to the
best of my knowledge and belief, this report is true and correct.
5. DATE

6. TITLE

7. SIGNATURE (Owner, Partner or Responsible Officer)

You must print the completed
form, sign and date lines 5 and 7,
and mail to the appropriate office
Return report to appropriate regional office; see separate instructions for information.
This report is to be filed pursuant to the Packers and Stockyards Act, 1921, as amended and supplemented, by 7 U.S.C. 181 - 229) and the
regulations issued thereunder. The Packers and Stockyards Act, 1921, as amended and supplemented provides in part that: “Any person who
shall willfully make, or cause to be made, any false entry or statement of fact in any report required to be made under this Act ... shall be deemed
guilty of an offense against the United States, and shall be subject, upon conviction in any court of the United States of competent jurisdiction, to
a fine of not less that $1,000 nor more than $5,000, or to imprisonment for a term of not more than three years, or to both such fine and
imprisonment.”
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 is 0580-0015. The time required to complete this information
collection is estimated to average 30 minutes per response, including the time to review instructions, search existing data resources, gather the
data needed, and complete and review the information collection.

AUGUST 2007

P&SP-3500

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