Form PPQ 505B PPQ 505B Plant and Plant Product Declaration Supplemental Form

Lacey Act Declaration Requirement; Plants and Plant Products

PPQ 505B JUN 2016 (SEC)

Businesses

OMB: 0579-0349

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PLANT AND PLANT PRODUCT DECLARATION
SUPPLENTAL FORM

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

SECTION 3 – Lacey Act Amendment (16 U.S.C. 3372)

ENTRY NUMBER

PAGE

OF

For each article or component of an article, provide the following:
11. HTS NUMBER
(no dashes/symbols)

12. ENTERED
VALUE

13. ARTICLE/COMPONENT OF
ARTICLE

14. PLANT SCIENTIFIC NAME
Genus
Species

I certify under perjury that, to the best of my knowledge and belief, the information furnished is true and correct.
PREPARER’S NAME (printed)
PREPARER’S SIGNATURE
EMAIL ADDRESS

PPQ FORM 505B
JUN 2016

15. COUNTRY
OF HARVEST

16. QUANTITY
OF PLANT
MATERIAL

17. UNIT

TELEPHONE NUMBER

DATE (MM/DD/YYYY)

(NOTE: Knowingly making any false statement in this Declaration for importation may subject the declarant to criminal penalties in accordance with 16 U.S.C. 3373(d)).
(Previous editions are obsolete.)

18. PERCENT
RECYCLED


File Typeapplication/pdf
AuthorHarris, Sheniqua M - APHIS
File Modified2019-02-25
File Created2019-02-19

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