CPR-2 Report of Payments to Cooperative Associations

Return

to: Federal Milk Order No. 1-Northeast Marketing Area
333 North Fairfax Street
Mailing Address: P.O. Box 25828
Alexandria, V A 2231 3-5828
Tel: (703) 549-7000
(703) 549-7003

CPR-2
Forñ Approved, OMB No. 0581-0032
lhis r€pon is aequied bythe ordea ¡n
accordânce wfh 7 U.S.C.60Ec and d. Failure to
rcpod can rcsult in lhc a$csñent of a civil
penalt¡y ofup to S1,000 per day (7 U.S.C.608c
(Í4Xg)) or, upon conviclion, in a f¡e otup to
55,000 per day (7 U.S.C.60Ec (l4XA)).

-Fax
Email: [email protected]
Website: www.fmmone.com
REPORT OF PAYMENTS TO COOPERATIVE ASSOCIATIONS
Name of Cooperative Association:
Address:
Pounds

Amount

Rate

Producer Milk

$

$

Butterfat
Protein
Other Solids

Value of Milk $
Other Charges: (ldentify)

Pounds
$

D

Adjustments: (ldentify)

TotalAmount Due $
RECONCILIATION OF BILLING AND PAYMENTS
Date

Check No.

Pounds

Amount

Rate

Partial Payment

$

$

Cther:

inal Payment

TotalAmount Paid $
I declare under the penalties provided by law, that this report (including schedules and statements), has been examined by me and to the best of
my knowledge and belief is true, correct, and complete. I also certifu that I am authorized to sign th¡s report.

Authorized
Handler:

Delivery
Month:

Signature:
Title:
Date:

SUBMIT A SEPARATE REPORT FOR EACH COOPERATIVE TO THE MARKET ADMINISTRAToR AT THE ABoVE ADDRESS oN oR BEFoRE THE 21SI oF THE MoNTH

According to the Papenruork 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 at (202) 720-2600 (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, 1400lndependence Avenue, S.W.,
Washington, D.C. 20250-9410, or call (866) 632-9992 (English) or (800) 877-8339
(TDD) or (866) 377-8642 (English Federal-relay) or (800) 845-6136 (Spanish Federalrelay). USDA is an equal opportunity provider and employer.