H-12 Expected 1000.9(c) Movements to Pool Plants

UNITED STATES DEPARTMENT OF AGRICULTURE
1930-220th St. SE, Ste. 102

Bothell, WA98021-8471
Phone: (425) 487-6009
Fax: (425) 487-2775
E-mail: fmmaseattle@fmmaseattle. com

AGRICULTURAL MARKETING SERVICE
DAIRY PROGRAMS
FEDERAL MILK ORDERS I24

& I3I

10050 N 25th Ave., Ste. 302
Phoenix, 42 85021-1664
Phone: (602) 547-2909
Fax: (602) 547-2906
E-mail: [email protected]

H-12
Expected 1000.9(c) Movements to Pool Plants

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

Aðcording to the Papenivork 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 t hour 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
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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 (86ô) ô32-9992
(English) or (800) 877-8339 (TDD) or (866) 377-8642 (English Federal-relay) or (800) 845-6136 (Spanish Federal-relay), USDA is
an equal opportunity provider and employer.

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
DAIRY PROGRAMS

Form H-12
1930-220th St. SE, Ste. 102

Bothell, WA98021-8471
Phone: (425) 487-6009
Faxi (425) 487-2775
E-mail: [email protected]

FEDERAL MILK ORDERS I24

&

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

Phoenix, 4285021-1664
Phone: (602) 547-2909
Fax (602) 547-2906
E-mail: [email protected]

13I

COOPERATIVE ASSOCIATION HANDLERS
EXPECTED $ 1000.9(c) MOVEMENTS TO POOL PLANTS
AND DIVERSIONS FROM POOL PLANTS
Month:

Cooperative:

Pool Plant

Expected $ 1000.9(c)
Movements
to the Plant
Product Pounds

Expected $ 1000.9(c)
Diversions
from the Plant
Product Pounds

1.

2.
3.
4.
5.

6.

Total

This report is required by the order in accordance with 7 U.S.C. 60Bc 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. 60Sc (14)(B)) or, upon conviction, in a fine of up to
$5,000 per day (7 U.S.C. 608c (14)(A)).
I declare under the penalties provided by law, that this report (including any accompanying schedules and

statements) has been examined by me and to the best of my knowledge and belief is a true, correct, and complete
report. I also certify that I am authorized to sign this report.

Name of Handler

Date

Title