9060-5 Meat and Poultry Export Certificate of Wholesomeness

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 0583-0153. The time required to complete this information collection is estimated to
average 25 minutes per response, including the time for reviewing instruction, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information.
U.S. DEPARTMENT OF AGRICULTURE
FOOD SAFETY AND INSPECTION SERVICE

Meat and Poultry Export Certificate of Wholesomeness
1. COUNTRY OF DESTINATION

2. ISO CODE

A knowingly false entry or false alteration of any entry on this certificate may result in a fine of not
more than $10,000 or imprisonment for not more than 5 years or both (18 U.S.C.1001).
Additional penalties exist under the Federal Meat Inspection Act [21 U.S.C. 611(b) (1), (2); and
(5), 21 U.S.C. 461] for an unauthorized or false alteration or misuse of this certificate.

6. CERTIFICATE TYPE
ORIGINAL

5. CERTIFICATE NUMBER

MPX-

REPLACEMENT
PRODUCT EXPORTED FROM:

3. CONSIGNOR/EXPORTER (Applicant's name and address)

7. EXPORT EST. NO. (Name and address)

4. CONSIGNEE/IMPORTER (Name and address)

9. TOTAL NO. OF PACKAGES

8. TOTAL NET WEIGHT

10.
DESCRIPTION OF PRODUCT
(Name of product)

11.
NET WEIGHT OF
LOT¹

12.
SPECIES

13.
NUMBER OF
PACKAGES
IN LOT¹

14.
TYPE OF
PACKAGES
IN LOT¹

15.
SHIPPING/
IDENTIFICATION
MARKS¹

16.
EST. NO.
ON
PRODUCT

¹ As stated by applicant or contractor

17. REMARKS

18. I CERTIFY that the meat, meat food product or meat byproduct specified hereon is from animals that received both antemortem and postmortem
inspection and were found sound and healthy and that it has been inspected and passed as provided by law and regulations of the Department and is sound
and wholesome.
19. I CERTIFY that the poultry, poultry products or poultry food products specified above came from birds that were officially given an antemortem and
postmortem inspection and passed in accordance with applicable laws and regulations of the United States Department of Agriculture and are wholesome
and fit for human consumption.
NOT VALID UNLESS SIGNED BY A CERTIFYING OFFICIAL OF MEAT AND POULTRY INSPECTION PROGRAM
20. CERTIFYING OFFICIAL'S NAME AND TITLE

21. DATE SIGNED (MM/DD/YYYY)

By order of the
Secretary of Agriculture

This certificate is receivable in all courts of the United States as prima facie evidence of the truth of the statements therein contained.
This certificate does not excuse failure to comply with any of the regulatory laws enforced by the United States Department of Agriculture.
FSIS FORM 9060-5 (06/29/2018)

PREVIOUS EDITIONS ARE OBSOLETE

ORIGINAL