P&SP 2500 Termination of Trust Fund Agreement or Trust Agreement

OMB CONTROL NO. 0580-0015

U.S. Department of Agriculture Grain Inspection, Packers and Stockyards Administration Packers and Stockyards Program

Termination of Trust Agreement or Trust Fund Agreement

1. Date: __________________________

Part I – Termination

2. Name of Registrant or Packer and Address (Street and No., City, State and Zip Code)

3. Name and Address of Trustee (Street and No., City, State and Zip Code)

Agreement Identification

4. Trust Agreement No. ___________________ or 5. Trust Fund Agreement No. ____________________

6. Value of Collateral $_______________________ 7. Effective Date: ______________________________

8. Termination Date: _______________________________________________________________________

Part II – Statement of Obligations for Livestock Purchased or Sold

Your agreement is terminated thirty (30) days following the date of receipt of your request with Packers and Stockyards Program.

The trustee is prohibited from releasing the collateral until a satisfactory showing has been made to the Deputy Administrator, Packers and Stockyards Program, that all obligations arising under the terms of the agreement have been satisfied.

Complete this report after the termination date then return to the above address.

9. Does the registrant or packer named above (Part I, line 2) owe or have any outstanding obligations for livestock purchased or sold (including for checks or drafts which have been issued in payment for livestock which have not been presented for payment or actually paid) during the period in which the agreement was in effect?

 NO

 YES

(If yes, please attach a list of livestock sellers to whom payment has not been made and the amount owed each seller. List the amount and date of each check and draft that has been issued in payment for livestock that has not been presented for payment and actually 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.

____________________________________ ____________________________________

10. Signature Of Registrant/Packer 11. Date

Return report to appropriate regional office; see separate instructions for information.

Part III – Collateral

Because the registrant or packer has certified that all obligations arising under the terms of the agreement have been paid, we now authorize the trustee to release the collateral pledged.

12. Letter of Credit Identification (If Applicable)	13. Date
14a. Signature	14b. Title

Execution of special report is required to insure all livestock sellers have received payment before collateral held under the trust agreement or trust fund agreement will be released (9 CFR 201.34 (c)). Information held confidential (9 CFR 201.96).

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 .75 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.

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.”

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

Form P&SP-2500 August 2007 Page 3 of 3