Membership Report by Order 30 Qualified Cooperative Asso

FEDER,AL MILK MARKET ADMINISTRATOR
UPPER MIDWEST MARKETING AREA
P.O. 80X 4469
LtsLE, tLtNOtS 60532_94ô9

MEMBERSHIP REPORT BY ORDER 3O QUALIFIED COOPERATIVE ASSOCIATION
(1) NOTTCE OF ADDtTtON TO MEMBERSHTp

(2) NOTICE OF MEMBER TRANSFERRING BETWEEN

PATRON
NUMBER

oMB NO. 0581-0032

PATRON'S NAME (FIRST AND LAST)
ADDRESS & LOCATION OF FARM

PLANTS

EFFECTIVE
DATE OF
CHECK OFF

OLD MEMBER TRANSFERRING
TO ABOVE PLANT FROM
PATRON NO

The records of th¡s assoc¡ation are avaìlable for your examinat¡on for the purpose of verif¡ng the above data

the data needed, and completing and reviewing the collection of information.

(Spanish Federal-relay). USDA ¡s an equat opportunity provider and employer.