Form LPS-234 USDA Processed Egg & Egg Products Export Certificate

OMB APPROVED: NO. 0581-NEW

U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
LIVESTOCK, POULTRY, AND SEED PROGRAM

USDA PROCESSED EGG AND EGG PRODUCTS EXPORT CERTIFICATE
NAME AND ADDRESS OF CONSIGNOR/EXPORTER:

CERTIFICATE NUMBER:

COMPETENT AUTHORITY:

NAME AND ADDRESS OF CONSIGNEE/IMPORTER:

STATE OF ORIGIN:

COUNTRY OF DESTINATION:

PLACE OF LOADING:

DECLARED POINT OF ENTRY:

MEANS OF TRANSPORT:

CONDITIONS OF TRANSPORT/STORAGE:

PRODUCER/MANUFACTURER:

DATE OF PACKING:

TYPE OF PACKING:

NAME OF PRODUCTS:

NUMBER OF PACKAGES:

NET WEIGHT:

ATTESTATIONS:

CERTIFICATION
DATE:

PRINTED NAME:
SIGNATURE:

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 0581-0NEW. The time required to complete this information collection is estimated to average 12 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, 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 contact 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, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382
(TDD). USDA is an equal opportunity provider, employer, and lender.

LPS-234 (12-2016)