Pima Cotton Agriculture Trust Fund

Affidavit of Shirting Manufacturer to Claim Payment from

Pima Agricultural Cotton Trust Fund

Filed pursuant to

Section 12314 of the Agricultural Act of 2014 (P.L. 113-79)

(1) The undersigned, __________(your name)__________________, certifies and affirms that I am __(title) ____ of __(name of company)_____, an officer of a manufacturer that cuts and sews men’s and boys’ woven cotton shirts in the United States.

(2) I certify and affirm that ___(name of company)___ has a manufacturing facility that cuts and sews men’s and boys’ woven cotton shirts located at ___(address)___, and has manufactured (cut and sewn such apparel items) at such address, during calendar year 2013 through today using fabrics described in paragraph (4) below.

(3) I certify and affirm that __(name of company) _____ used imported cotton fabric during calendar year 2013 to cut and sew men’s and boys’ woven cotton shirts in the United States as such term described in section 12314 of the Agricultural Act of 2014 (P.L. 113-79).

(4) I certify and affirm that __(name of company) purchased $­­­________ of imported woven cotton shirting fabric of 80s or higher count and 2-ply in warp during calendar year 2013.

(5) I certify and affirm that __(name of company)____ maintains invoices along with other supporting documentation (such as price lists and other technical descriptions of the fabric qualities) showing the dollar value of such fabric purchased, the date of purchase, and evidencing the fabric as woven cotton fabric of 80s or higher count and 2-ply in warp. For purposes of this affidavit, the date of purchase is the invoice date, and the dollar value is determined excluding duty, shipping, and related costs. The supporting documentation includes one or more of the following types of documents: _______________, ________________, ____________________, or ________________________.

(6) I certify and affirm that the fabric referenced herein was suitable for use in the manufacturing of men’s and boy’s cotton shirts.

I certify and affirm that to the best of my knowledge and belief all information contained in this claim and affidavit is complete and correct and no false claims, statements, or representations have been made.

_________________ _____________________________________

date signature

_____________________________________

title

___________________________________

company name ____________________________________

address

( State of ____________________________

( County/City of _______________________

__(name) _______subscribed and sworn to before me this affidavit for a claim for payment from the Pima Cotton Trust Fund this __ day of June, 2007.

Signature of Notary Public

__________________________________

My Commission expires _____________