Designation of Persons Authorized to Sign Handler Report

USDA, AMS, Dairy Programs
Market Administrator
1550 North Brown Rd., Ste. 120, Lawrenceville,
(7701682-2501

GA 30043

Desiqnation of Persons Authorized to Siqn Handler Reports

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponso¡', and a person is
not rcquired 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 058 t-0032. The time required to complete this
information collection is estimated to average .5 hours per rcsponse, including the timè for reviewing
iustructions, 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 infonnation, reprisal, or because all or.part
of an individual's income is derived fiom any public assistance program. (Not all prohibited bases apply to all

plograms.) Persons with disabilities who rcquire 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, 1400 Independence Avenue, S.W., Washington, D.C.2O25O-9410, or
call (866) 632-9992 (English) or (800) 877-8339 (TDD) or (866) 377-8642 (English Federal-relay) or (800)
845-6136 (spanish Federal-relay). usDA is an equal oppoftunity provider and employer.

Form Approved, 0MB 0581-0032

UNITED STATES DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE DAIRY PROG RAMS
MARKET ADMINISTRATOR

Federal Orders 6 and 7
1550 North Brown Rd., Ste. 120,
Lawrenceville, Georgia 30043

DESIGNATION OF PERSONS AUTHORIZED TO SIGN HANDLER REPORTS

The following person or persons are hereby designated to sign report forms submitted as a handler under the
orders shown above. This designation is to be made by the owner, in the case of an individual proprietorship;
by a partner, in the case of a partnership; by an officer, in the case of a corporation; or by a trustee or receiver
who has been appointed by or with the consent of a court of law.

CHECK REPORTS
AUTHORIZED TO SIGN

nurHonrzro

runur

. lndicate "all" for any person who is designated to sign

OFFICIAL COMPANY NAME:

Receipt & Producer
SIGNAIUßE Utitization pagoll

TTTLE

Other*

att repofts.

ADDRESS:
(City and State)

PARENT COMPANY:

DATE:

SIGNED:

TITLE: