H-13 Expected Bulk Milk receipts and Usage

UNITED STATES DEPARTMENT OF AGRICULTURE
'1930-220th St. SE, Ste. 102
Bothell, WA 98021 -8471
Phone: (425) 487-6009
Fax: (425) 487-2775
E-mail: fmmaseattle@fmmaseattle. com

AGRICULTURAL MARKETING SERVICE
DAIRY PROGRAMS
FEDERAL MILI( ORDERS I24

&

13I

10050 N 25th Ave., Ste. 302

Phoenix, AZ85021-1664
Phone: (602) 547-2909
Fax: (602) 547-2906
E-mail: [email protected]

H - 13

Expected Bulk Milk Receipts and Usage

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

According to the Paperurork 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
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 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) 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 opportunity provider and employer.

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING

Form H-13

SERVICE

Form Approved, OMB No. 0581-0032

DAIRY PROGRAMS

1930-220th St. SE, Ste. 102
Bothell, WA98021-8471
Phone: (425) 487-6009

FEDERAL MILK ORDERS I24

Fax: (425) 487-2775

10050 N 25th Ave., Ste. 302

&

Phoenix, AZB5021-1664
Phone: (602) 547-2909
Fax: (602) 547-2906

13I

E-mail: fmmaseattle@fmmaseattle. com

E-mail: [email protected]

DISTRIBUTING PLANT
EXPECTED BULK MILK RECEIPTS AND USAGE
Month:

Handler:
Plant Location:

A) Expected Grade A Receipts

1.
2.

Product Pounds

Producers
$ .9(c) coops. (specify)
a.
b.

3.

c.

Other Bulk Grade A (specify)
a.
b.

4.

c.

Total

B) Exoected Class I Needs

1.
2.
3.

Fluid Milk Products packaged in the plant
Other Class I Needs (specify)
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. 608c (f 4)(B)) or, upon conv¡ction, in a fine of
up to $5,000 per day (7 U.S.C. 60Bc (14X4)).
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

Authorized Signature

Title