PPQ Form 626 Petition for Remission or Mitigation of Forfeiture

Clear Form
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 0579-0076. The time
required to complete this information collection is estimated to average .5 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
0579-0076
EXP. XX/XXXX

FILE No.

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
PLANT PROTECTION AND QUARANTINE

PETITION FOR REMISSION OR MITIGATION OF FORFEITURE
Filing of this petition is required for remission of seized property. Information will be used in determining whether the petition is granted or denied (7CFR 356).
TO

1. DATE AND TIME OF SEIZURE
USDA-APHIS
Plant Protection and Quarantine
2. PLACE OF SEIZURE
City

State and ZIP Code

3. DESCRIPTION OF PROPERTY

4. NAME AND ADDRESS OF PETITIONER

5. EVIDENCE OF YOUR INTEREST IN THE PROPERTY SUCH AS CONTRACTS, BILLS OF SALE, INVOICES, CERTIFICATES OF TITLE, ETC. (attach copies of any
documents)

6. STATEMENT OF ALL FACTS AND CIRCUMSTANCES RELIED UPON BY THE PETITIONER TO JUSTIFY REMISSION OR MITIGATION OF THE FORFEITURE

7. SIGNATURE OF PETITIONER OR PETITIONER’S ATTORNEY AT LAW (if a business, the signature must be that of a partner, officer, or attorney at law) 8. DATE SIGNED

PPQ FORM 626
JUL 2018