MA-B Brokerage Report

MA-B
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))."

FEDERAL MILK ORDER No. 1
Albany:
302A Washington Avenue Ext.
Albany, NY 12203-7303
Tel: (518) 452-4410

Handler Name

Northeast Marketing Area
89 South Street
Boston, MA 02111-2671
Tel: (617) 737-7199

Alexandria:
P.O. Box 25828
Alexandria, VA 22313-5828
Tel: (703) 549-7000

BROKERAGE REPORT
REPORT OF PRODUCT MOVEMENTS NOT OTHERWISE REPORTED

For Month of ________________________ 20 ______

Report on this form all movements of bulk fluid milk products and
fluid cream products made at your direction, for which you are not
required to submit a plant report or a bulk tank unit report to the
Market Administrator.
This report properly prepared and signed must be submitted to
the above address on or before the 10th of the month following the
month for which the report is prepared.

DO NOT WRITE IN SHADED AREAS

SHIPPER
Handler Name

For Market Administrator Use Only

RECEIVER
Plant Location or Bulk
Tank Unit Name

Code

Handler Name

PRODUCT
Plant Location

Code

Name

Code

Pounds of
Product

Pounds of
Butterfat

Class

SHIPPER
Handler Name

RECEIVER
Plant Location or Bulk
Tank Unit Name

Code

Handler Name

PRODUCT
Plant Location

Code

Name

Code

Pounds of
Product

Pounds of
Butterfat

Class

For Market Administrator Use Only

For Market Administrator Use Only

Operator 1

The information provided is complete and accurate to the best of my knowledge and belief.

Handler's Name:
Operator 2

Signed by:
(Person authorized to sign on behalf of handler)

Title:

Date:

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 0.25 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, 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 contace 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, DC 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.