Form PPQ 540 PPQ 540 Certificate of Federal/State Domestic Plant Quarantines

Information requested is needed to determine if a
permit can be issued (7 CFR 301).
FORM APPROVED: OMB NOS. 0579-0088 &
0579-0123
See reverse side for additional information.

FORM APPROVED
OMB NOS. 0579-0088
AND 0579-0248

No.

U.S. DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
PLANT PROTECTION AND QUARANTINE

LIMITED PERMIT

This permit authorizes the movement of the NONCERTIFIED articles described below to
a specified destination for limited handling, utilization, or processing, or for treatment. The
movement of such articles is regulated by Federal or State cooperative domestic plant
quarantines.
1. DATE ISSUED

2. VOID AFTER

3. NAME OF CONSIGNOR

4. SHIPPING POINT

5. NAME AND ADDRESS OF CONSIGNEE

6. VEHICLE LICENSE NO. & STATE

7. R.R. CAR INITIALS

8. DESCRIPTION
A. Quantity

B. Article

C. Remarks

9. SIGNATURE OF ISSUING OFFICER

ENDORSEMENT
The above described shipment was received by the designated
consignee, and was handled in the manner approved under the
provisions of all applicable Federal or State cooperative
domestic plant quarantines.
10. DATE RECEIVED

11. SIGNATURE OF DESTINATION OFFICER

PENALTY FOR MISUSE OR ALTERATION (7 USC 163)
PPQ FORM 530 (FEB 2002)
Previous edition dated APR 89 may
be used.

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 numbers for this
information collection are 0579-0088 and 0579-0248. The time required
to complete this information collection is estimated to average .20 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.

PPQ FORM 540 (REVERSE)

COPY DESIGNATIONS

PART 1 - CONSIGNEE'S COPY

PART 2 - DESTINATION
OFFICER'S COPY

PART 3 - ISSUING OFFICER'S
COPY

CERTIFICATE OF
FEDERAL/STATE DOMESTIC
PLANT QUARANTINES

From:
To:

PPQ FORM 540
(APR 89)

Previous edition obsolete.