Form PPQ 540 PPQ 540 Certificate

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 numbers for this information collection are 0579-0088, 0281, 0322, 0331, 0337, 0346, 0363, and 0369. The time required to complete this information collection is estimated to average between .16 and 2 hours 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.

OMB Approved 0579- 0088, 0281, 0322, 0331, 0337, 0346, 0363, and 0369

Information requested is needed to determine if a permit can be issued (7 CFR 301).

E

United States Department of Agriculture

Animal and Plant Health Inspection Service

Plant Protection and Quarantine

certificate

This certificate must be surrendered to the

consignee at destination of shipment.

The articles described below are certified under all applicable Federal or

State cooperative domestic plant quarantines.

1. Date issued

2. Void After

3. Name of Consignor

4. shipping point

5. name and address of consignee

6. vehicle License Number and state

7. R.R. car initials and number

8. description

A. Quantity

B. Article

C. Remarks

9. signature of issuing inspector

Penalty for misuse or alteration (7 U.S.C. 163)

PPQ FORM 540 PART 1 - CONSIGNEE

FEB 2014