Producer Handler Report of Receipts & Utilization

UNITED STATES DEPARTMENT OF AGRICULTURE
1325 Industrial Parkway North
P.O. Box 5102

Agricultural Marketing Service - Dairy Programs

Brunswick, Ohio 44212

Federal Order No. 33

MIDEAST MARKETING AREA

Phone: (330) 225-4758
Toll Free: (888) 751-3220
Fax: (330) 220-6675

OMB No. 0581-0032

This report is required by the order in accordance with 7 U.S.C. 608c 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(14)(B)) or, upon conviction, in a fine of up to $5,000 per day (7 U.S.C. 608c (14)(A)).

PRODUCER HANDLER REPORT OF RECEIPTS AND UTILIZATION
____________________________________________________________________________

Month and Year _________________

Plant Location and Mailing Address ____________________________________________________________________________________________
Line
No.
1

2
3
4
5
6
7
8

RECEIPTS
Own Farm Production (test
From Others:
(show name & address of suppliers)

Butterfat
Pounds

Product
Pounds

Butterfat
Pounds

)
Name of Product

TOTAL RECEIPTS FROM ALL SOURCES
Opening Inventory
TOTAL TO BE ACCOUNTED FOR
(add lines 1 through 7)

UTILIZATION

Bottled Sales
Gallons
9
10
11
12
13
14
15
16
17

Product
Pounds

Half Gallons

Quarts

Pints

Half Pints

% Test

Whole Milk
Flavored Milk
2% Lowfat
1% Lowfat
Skim
Flavored Lowfat Milk
Buttermilk
SUBTOTAL

(lines 9 through 16)

Sales to Plants: (indicate name & location of plant)

Name of Product

18
19
20
21
22
23
24
25
26
27
28
29
30

Milk, Skim & Cream Used to Produce:
Half & Half
Whipping Cream
Ice Cream Mix
Animal Feed
Dumped
Other
Ending Inventory
TOTAL UTILIZATION (add lines 17 through 27)
Overage
(excess line 28 over line 8)
Shrinkage
(excess line 8 over line 28)
I declare under the penalties provided by law that this report 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

Signature ___________________________________________
Date ___________________________

Title ________________________________________________
(Owner, Partner or Officer)

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 0581-0032. The time required to complete this information collection is estimated to average 30 minutes
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, genetic information, political beliefs, 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 at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400
Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.