Pima Cotton Agriculture Trust Fund

For Pima Agriculture Cotton Trust OMB No.: 0551-0044

Affidavit of Yarn Spinner to Claim Payment from

The Pima Agriculture Cotton Trust Fund in 2018

Filed pursuant to section 12314 of the Agricultural Act of 2014

(P. L. 113-79)

1. The undersigned, _______________________________________, certifies and affirms that I am ______________ of ______________________, an officer of a company that produces ring spun yarns in the United States measuring less than 83.33 decitex (exceeding 120 metric number), in single and plied form from pima cotton.

2. I certify and affirm that _____________________________________ produces yarns of pima cotton at its facility located at _____________________________ _______________________________________,including ring spun cotton yarns measuring less than 83.33 decitex (exceeding 120 metric number), in single and plied form from pima cotton during the period January 1, 2018 through today, and during calendar year 2013.

3. I certify and affirm that ___________________________________ produced __________ pounds of ring spun cotton yarns, measuring less than 83.33 decitex (exceeding 120 metric number), in single and plied form during calendar year 2013.

4. I certify and affirm that ____________________________ maintains supporting documentation showing the quantity of such yarns produced, and evidencing the yarns as ring spun cotton yarns, measuring less than 83.33 decitex (exceeding 120 metric number), in single and plied form during calendar year 2013.

I certify and affirm that to the best of my knowledge and belief all information contained in this claim and affidavit is complete and correct and no false claims, statements, or representations have been made.

_________________ _____________________________________

Date Signature

_____________________________________

Title

______________________________________

Company Name

______________________________________

______________________________________

Address

( State of ____________________________

( County/City of _______________________

____________________________________subscribed and sworn to before me this affidavit for a claim for payment from the Pima Agriculture Cotton Trust Fund this ___ day of _______________, 2018.

Signature of Notary Public

__________________________________

My Commission expires _____________

E-Mail completed and notarized form to: [email protected]

Public reporting for this collection of information is estimated to average 3 hours per response, including the time for reviewing instructions, and completing and reviewing the collection of information. All responses to this collection of information are voluntary, and will be provided confidentiality to the extent allowed under the Freedom of Information Act. Notwithstanding any other provision of the law, no person is required to respond to nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless the collection of information displays a current valid OMB control number. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Import Policies and Export Reporting Division at: [email protected]

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