Quarterly Revenue Report

US Forest Service (v05-2014)

OMB 0596-0087 Exp. 06/30/2014

	Quarterly Revenue Report FY___ Q2014
Item #		Item Description/Name	Gross Units Sold	Unit Selling Price ($)		Total Gross Sales ($)	Deductions ($)	Net Sales ($)	Royalties Earned ($)
Total Royalties This Period
(Less Advance Payment Balance, If Any)
Total Due									$
I hereby certify that the above statement is true and correct.					By ____________________________ Title _______________ Date _____________

Send original check, signed royalty report and price list to:	Send copies of check and royalty report plus price list to both:
USDA Albuquerque Service Center (ASC) ATTN: R&C – OTC 101B Sun Avenue NE Albuquerque, New Mexico 87109	The Metis Group LLC 888 17th Street NW Suite 620 Washington DC 20006 OR [email protected]	USDA FOREST SERVICE ATTN: Conservation Education, National Symbols Program Manager Stop Code: 1147 1400 Independence Avenue, SW Washington, DC 20250-1147

Zero sales must still report!

Burden Statement

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 0596-0087. 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, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. (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 USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer