Form TB-92 Tobacco Inspection Certificate

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SERIAL NUMBER
U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
TOBACCO PROGRAMS

TOBACCO INSPECTION CERTIFICATE
fUnder the Tobacco Inspection Act of 19351

INSPECTED FOR THE ACCOUNT OF (Name and Srreet address or P.0. Box, City,
State, and ZIP):

LOCATION OF INSPECTION (City and State);

PACKAGE MARKS

COUNTRY OF ORIGIN

CROP YEAR

NUMBER OF PACKAGES IN LOT

TYPE NUMBER

OFFICIAL GRADE

REMARKS

DATE OF INSPECTION

TB-92 (04- 2020) (Destroy Previous Editions)

SIGNATURE OF OFFICIAL INSPECTOR

NET WEIGHT

TB-92 (04-2020)
TOBACCO INSPECTION CERTIFICATE

USDA’s Nondiscrimination Statement
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and
employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion,
sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public
assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases
apply to all programs). Remedies and complaint filing deadlines vary by program or incident.
Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language,
etc.) should contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service
at (800) 877-8339. Additionally, program information may be made available in languages other than English.
To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/
complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To
request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: 1) mail: U.S. Department of Agriculture Office of the
Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; 2) fax: (202) 690-7442; or 3) email:
[email protected].
USDA is an equal opportunity provider, employer, and lender.

TB-92 (04- 2020) (Destroy Previous Editions)