HR-EZ Report of Receipts & Utilization (Schedules 1, 2, & 3)

UNITED STATES DEPARTMENT OF AGRICULTURE
1930-220th St. SE, Ste. 102
Bothell, WA 98021-8471
Phone: (425) 487-6009
Fax: (425) 487-2775

AGRICULTURAL MARKETING SERVICE
DAIRY PROGRAMS
FEDERAL MILK ORDERS I24

&

13I

E-mail: [email protected]

10050 N 25th Ave., Ste. 302
Phoenix, M.85021-1664
Phone: (602) 547-2909
Fax: (602) 547-2906
E-ma¡l: [email protected]

HR-EZ
Report of Receipts and Utilization
(includes schedules 1,2, and 3)

Note: This cover page is for information purposes only and does not need to be submitted to the market administrator's office.

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not 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 0581-0032. The time required to complete this information collection is estimated to average 1.0 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.

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, political beliefs genetic information, 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 al (202) 7202600 (voice and TDD). To file a complaint of discrimination, write to USDA, Assistant Secretary for Civil Rights, Office of the
Assistant Secretary for Civil Rights, 1400 lndependence Avenue, S.W., Washington, D.C. 20250-9410, or call (866) 632-9992
(English), (800) 877-8339 ODD) or (866) 377-8642 (English Federal-relay) or (800) 845-6136 (Spanish Federal-relay). USDA is
an equal opportunity provider and employer.

UNITED STATBS DBPARTMENT OF AGRICULTURtr
Form HR-EZ, Page

AGIìICU LTU IìAL MAIìKDTI NG SEIIVICB
DAIRY PROGRAMS

1

1930-220th St. SE, Ste. 102
Bothell, WA 98021-8471
Phone: (425) 487-6009
Fax: (425) 487-2775
E-mail: [email protected]

F'EDERAL MILI( ORDERS I24

Form Approved, OMB No. 0581-0032
10050 N 25th Ave., Ste. 302

Phoenix, A.285021-1664
Phone: (602) 547-2909
Fax: (602) 547-2906
E-mail: [email protected]

& I3I

REPORT OF RECEIPTS AND UTILIZATION

Handler Name
Plant Location
Monthl/'ear

ïhis

FOr rvr.

Month-Year

A. use unrv
Order

report is required by the order in accordance with 7 U.S.C. 60B c and d. Failure to report can result in the âqqêqemênt
of up to $1 ,000
U.S.C. 608c 14XB)) or, upon conviction, in a fine of up to $5,000

BEGINNING INVENTORIES
lass lV (Bulk)
For M.A. Use Only
Farm
Dairy

Production

Farms

lNo. of Farms
(No. of Farms)

OTHER RECEIPTS
ldentify Name, City, State

Nonfluid milk products: Class ll (from Sch. 'l , Line 15)
Lbs.
Nonfluid milk products: Class l, lll, & Loss (from Sch. 1, Line 16)
Lbs.
TOTAL RECEIPTS AND BEGINNING INVENTORIES
For M.A. Use Only

Total Class I Route Disposition (ln & Out of Mar

Used to Produce (ldentifv Producl

NFMS Used to Fortifu

FMP

Lbs.

TOTAL UTILIZATIONS AND ENDING INVENTORIES

34

SHRINKAGE

Date

(OVERAGE)M

Person Authorized to Sign for Handler

Handler:

TOTAL ROUTE DISPOSITION

Location:

FEDERAL ORDERS 124 & 131

1% Lowfat - Plain

ldentify products of different butterfat
RECONCILIATION OF NONFLUID MILK PRODUCTS

UNT
Used in Class ll
Used in Class lll

id: Class ll
id: Class I &

lll. (olus Loss

Month & Year

Form HR-EZ, Schedule'1

Handler:

Location:

FEDERALORDERS 124&131
OUT-OF-AREA ROUTE DISPOSITION

OUT.OF-AREA ROUTE DISPOSITION
PRODUCT (Specifv) 1/

Identify products of different
on separate lines.
ldentify Federal order number, city & state.

Month & Year:

Form HR-EZ, Schedule 2

Handler:

CLOSING INVENTORIES

Month&Year

FEDERAL ORDERS 124 &131

ldentify products of different

Total to Page

'1

, Line 16

Form HR-EZ, Schedute 3