Agriculture Wool Apparel Manufacturers Trust Fund

For 9902.51.16 OMB No.: 0551-NEW

Expires ##/##/####

APPLICATION FOR 2015 MONETIZED TRQ PAYMENTS

MANUFACTURERS OF WORSTED WOOL FABRIC

AVERAGE FIBER DIAMETER OF 18.5 MICRONS OR LESS

Data for January-December 2014

If data provided is to be treated as Business Confidential, please indicate prominently across top of form. 

Company Name:	_______________________	Contact Name:	______________________
Company Address:	_______________________ 	Contact Address:	______________________ 
	_______________________ 		______________________ 
	_______________________ 		______________________
Company Federal Tax Identification Number:	________________	Contact Telephone Number:		____________________ 
		Contact Email Address:		____________________

Signature of Representative Date

Signature of Notary Date

Certification Statement: I, the duly authorized representative, as an employee, officer or agent, with personal knowledge of the matters set out in the application, certify that the information contained herein is complete and accurate, signed and sworn before a Notary Public, and acknowledging that false representations to a federal agency may result in criminal penalties under federal law.

	Worsted Wool Fabric of 85% or More by Weight Wool of 18.5 Microns or Less
Period	January-December 2014
Quantity and Value	Square Meters	($)
Production (fob plant)		
Names and Addresses of Plants Weaving Worsted Wool Fabric of 85% or More by Weight Wool of 18.5 Microns or Less	1.
	2.
	3.
	4.
	5.
	6.

If additional space for listing plants and/or contractors is needed, use this page again after printing or attach a blank sheet of paper with the requested information.

E-Mail completed and notarized form to: IPERD@FAS.USDA.GOV