Monthly Report of Payments Received by Cooperative Assoc

USDA, AMS, Dairy programs
Market Administrator
1550 North Brown Road, Ste, 120, Lawrenceville, GA 30043
(7701682-2s01

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Form Approved, OMB 0581-0032

United States Department of Agriculture
Agricultural Marketing Service, Dairy programs
Market

phone: 7ZO-682-2s01
770-g22-1038
Fax:

Mailinq Address

Administrator

1ss0 N. Brown Rd

Federal Order No. 6 - Florida Marketing Area
Federal Order No. 7 - Southeast Marketing Area

Ste. 120
Lawrenceville' GA 30043

E-mail: Pool@fmmatianla con:
Home Page:'rvvr's/.fmnlatlanta. com

MONTHLY REPORT OF PAYMENTS RECEIVED BY COOPERATIVE ASSOCIATION FROM HANDLERS
COOPERATIVE ASSOCIATION

:

MONTH:

ORDER:

This report is required by the order in accordance with 7 U.S.C. 609c and d. Failure to report can result in
the assessment of a civil penalty
of up to $1,000 per day (7 U.S.C. 60Bc(14)(B)) or, upon conviction, in a fìne of up io 55,000 per day
tz u.si. éoOc t14XA)).

Gross
HANDLER
$

." lf applicable

Not

Amount

Adjustments

Amount

Due

C)or+

Due

$

uate

Amount
s

$

SECOND ADVANCE**
uate
Amount
Received

FIRST ADVANCE

Received
$

FINAL SETTLEMENT
Date

Amount
$

I declare under the penalties provided by law, that

this report (including any accompany¡ng schedu¡es and statements) has been examined by
me and to the best of my knowledge and belief is a true, corect and complete report. I also cert¡fy that I am authorized to sign th¡s report.

SIGNED:

TITLE:
(Person Authorized to Sign for Handier)

DATE:

Received