PPQ Form 626 Petition for Remission or Mitigation of Forfeiture

According to the Paperwork 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 0579-0076. The time required to complete this information collection is estimated to average .50 hours 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.								OMB APPROVED 0579-0076 Exp. Date
U.S. DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE PLANT PROTECTION AND QUARANTINE PETITION FOR REMISSION OR MITIGATION OF FORFEITURE						File Number:
Filing of this petition is required for remission of seized property. Information will be used in determining whether the petition is granted or denied (7CFR 356).
TO					1. DATE AND TIME OF SEIZURE
	USDA-APHIS Plant Protection and Quarantine
					2. PLACE OF SEIZURE
	City		State and ZIP Code
3. DESCRIPTION OF PROPERTY
4. NAME AND ADDRESS OF PETITIONER
5. EVIDENCE OF YOUR INTEREST IN THE PROPERTY SUCH AS CONTRACTS, BILLS OF SALE, INVOICES, CERTIFICATES OF TITLE, ETC., (Please attach copies of any documents)
6. STATEMENT OF ALL FACTS AND CIRCUMSTANCES RELIED UPON BY THE PETITIONER TO JUSTIFY REMISSION OR MITIGATION OF THE FORFEITURE
7. SIGNATURE OF PETITIONER OR PETITIONER’S ATTORNEY AT LAW (if a business, the signature must be that of a partner, officer, or attorney at law)							8. DATE SIGNED

PPQ FORM 626 Previous edition may be used.

FEB 2012