Form 1 Report of Receipts & Utilization (Suplements A,B,C & D)

United States Department of Agriculture

1325 Industrial Parkway North

OMB No. 0581-0032

AGRICULTURAL MARKETING SERVICE
DAIRY PROGRAMS
Mideast Marketing Area
Federal Order No. 33

P.O. Box 5102
Brunswick, Ohio 44212
Phone: 330/225-4758
Toll Free: 888/751-3220
Fax: 330/220-6675

Exp. XX/XXXX
Form 1

REPORT OF RECEIPTS AND UTILIZATION

Email: [email protected]

HANDLER

MONTH
This report is required by the order in accordance with 7 U.S.C. 608c and d. Failure to report can result in the assessment of a civil
penalty of up to $1,000 per day (7 U.S.C. 608c (14)(B)) or, upon conviction, in a fine of up to $5,000 per day (7 U.S.C. 608c (14)(A)).

For MA Use Only

RECEIPTS

Coop
Sec Item O. Hdlr

001 030
001 030
003
004
005
006
007

620
620
621
621
621

Code

Producer Milk:
Cooperative members:

POUNDS
Butterfat

Somatic Cell

Protein

Other Solids

Value + or -

0

0

$0.00

000 Own Production
000 Nonmember
Total Producer Milk
Nonfluid - Class II Used to Produce Only
Nonfluid - Other Class
Reconstituted Labeled Products From Unreg. Supply Plants
Reconstituted Labeled Products From Any Order
Reconstituted Labeled Products From Any Order Per Sec. 43(d)
Other Receipts of Fluid Milk and Cream Products
List in detail below:
Handler or Plant and Location

031
033

Product

Prod.

Bulk

Div.

or

FM

Pkg.

or TK

0
0
0
0
0

0

0

0

NOTES:

Class

Beginning Inventory - Packaged Fluid Milk Products
Beginning Inventory - Bulk Fluid Milk Products and Bulk Fluid Cream Products
Total Receipts From All Sources

CLASS I ROUTE DISPOSITION
Product

Sec. Item
041

110 Whole Milk

041

140 Flavored Whole Milk Products

041

149 Eggnog

041

170 Organic Whole Milk

041

174 Organic Flavored Whole Milk

041

211 2% Reduced Fat Milk - No Solids Added

041

212 2% Reduced Fat Milk - Solids Added

041

221 1% Lowfat Milk - No Solids Added

041

222 1% Lowfat Milk - Solids Added

041

225 1/2% Lowfat Milk - No Solids Added

041

226 1/2% Lowfat Milk - Solids Added

041

231 Fat Free Milk - No Solids Added

041

232 Fat Free Milk - Solids Added

041

240 Flavored Lowfat & Skim Milk

041

240 Flavored Lowfat & Skim Milk

041

250 Buttermilk

041

271 Organic 2% Reduced Fat Milk

041

272 Organic 1% Reduced Fat Milk

041

273 Organic Fat Free Milk

041

274 Organic Flavored Fat-Reduced Milk

041

292 Sweet Acidolphilus

041

296 Lactose Reduced

041

5 Gallons

Gallons

Half-Gal.

Quarts

Pints

Page 2
10 Ounces

Other: Identify

041

999

TOTAL CLASS I ROUTE DISPOSITION

042

975

Ending Inventory of Packaged Fluid Milk Products
Total Class I

1/2 Pints

4 Ounces

BF
Test

POUNDS
Product

Butterfat

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0

0

CLASS II DISPOSITION
REPORT VOLUME USED TO PRODUCE

Sec. Item
049

310 Mixtures Half/Half - 9% or more B/F

049

321 Light Cream

049

322 Heavy Cream

049

330 Sour Cream

049

340 Yogurt

049

380 Cottage Cheese

049

385 Ricotta Cheese

049
049

POUNDS
Product

Butterfat

Other Soft, High Moisture Cheeses (Identify)
Other (Identify)

049

721 Ice Cream Mixes

049

722 Milkshake Mixes

049

934 Custards, Puddings, Pancake & Biscuit Mixes

049

590 Concentrated Product Used to Produce Class II

049

970 Skim Milk Equiv. of Nonfat Solids Added Cl. II - Used to Produce Items Only

0

049
Total Class II

0

0

For MA Use Only
Sec Item

CLASS III DISPOSITION

Page 3

POUNDS
Product
Butterfat

REPORT VOLUME USED TO PRODUCE

071 810
071 830
071

Hard Cheese : American
Italian
Other : Identify

071 590
071 521
071 590
071

Concentrated Products Used to Produce Class III
Unsweetened Condensed
Other Condensed Product
Other : Identify

Total Class III

0

CLASS IV DISPOSITION
Sec. Item
081 400

0

POUNDS
Product
Butterfat

REPORT VOLUME USED TO PRODUCE

081 620
081 600

Butter
Milk Product in Dried Form:
Nonfat Dry Milk
Whole Milk Powder

081 590

Concentrated Products Used to Produce Class IV Product

081 970
081 975

Skim Milk Equivalent of Nonfat Solids Added to Class I Products
Ending Inventory of Bulk Fluid Milk Products and Bulk Fluid Cream Products
Total Class IV

0

0

BULK FLUID MILK PRODUCTS AND DIVERSIONS TO COMMERCIAL FOOD PROCESSORS

O
Sec. Item Hdlr
069 070 321
069 050 321

Name and Location

Bulk

If Div.

or Div.

F or T

Total to Commercial Food Processor

OTHER USES - Assigned to Lowest Price Class For Month
Sec.
071
071
071

Item
941
950
950

Disposed of as Livestock Feed
Disposed of as Dumped
Lost in vehicular accident, flood, fire or similar occurrence beyond handler control
Total Other Uses

POUNDS
Product
Butterfat

0

0

POUNDS
Product
Butterfat

0

0

For MA Use Only
Sec Item O Hdlr

MILK DIVERTED FROM FARMS TO OTHER PLANTS
HANDLER AND PLANT LOCATION

Coop

F or T
Weight

Class
Req.

Total Milk Diverted From Farms

Page 4

POUNDS
Product
Butterfat

0

0

TRANSFERS OF FLUID MILK PRODUCTS AND BULK FLUID CREAM PRODUCTS TO OTHER PLANTS

For MA Use Only
Sec Item O Hdlr

HANDLER AND PLANT LOCATION

Total Transfers of Fluid and Bulk Fluid Cream Products

Product

Bulk
or Pkg.

Class
Req.

POUNDS
Product
Butterfat

0

0

Line
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Identify By Source

RECONCILIATION OF NONFLUID PRODUCTS

Plant Identification
Opening Inventory
Own manufacture
Purchases
Sales
Ending Inventory
TOTAL TO ACCOUNT FOR
Used in Class I - Fortify
Used in Class I - Reconstituted
Used in Class I - Labeled Reconstituted From Unregulated Supply Plants
Used in Class I - Labeled Reconstituted From Any Order
Used in Class II
Used in Class III
Used in Class IV
TOTAL ACCOUNTED FOR
Loss or (Gain) - Loss To Receipts
(1)
Product

Powder

(

Powder

)(
(

Page 5

Powder

Condensed 50% or more TMS

) (
) (

) (
) (

)
)

0

0

0

0

0
0

0
0

0
0

0
0

0
0

(5)
Conv. Factor
9.89

Equiv. to Cl. IV
Pg. 3, Sec. 081 970 (2) X (5)
0
0

(2)
Product Pounds
0
0
0
0

(3)
Conv. Factor
10.54
10.54

0
0

10.54

0
0

10.54

0
0

10.54
10.54

(4)
Equiv. Pounds (2) X (3)
0
0
0
0
0
0
0
0
0
0
0
0

RECONCILIATION OF RECEIPTS AND UTILIZATION
TOTAL RECEIPTS FROM ALL SOURCES - PAGE 1
Total Class I - Page 2
Total Class II - Page 2
Total Class III - Page 3
Total Class IV - Page 3
Total Bulk FMP and Diversion to Comm. Food Processors - Page 3
Total Other Uses, Page 3
Total Milk Diverted from Farms - Page 4
Total Transfers of Fluid Milk and Bulk Fluid Cream Products - Page 4
TOTAL UTILIZATION
OVERAGE
SHRINKAGE

)
)

0

OTHER SOURCE NONFLUID MILK PRODUCTS TO RECEIPTS AND UTILIZATION

Powder - Line 7 Above
Condensed - Line 7 Above
Powder - Line 8 Above
Condensed - Line 8 Above
Powder - Line 15 (Loss Only)
Condensed - Line 15 (Loss Only)
TOTAL to Page 1; Sec. 004
Powder - Line 11 Above
Condensed - Line 11 Above
TOTAL to Page 1; Sec. 003 & to Page 2; Sec. 049 970
TOTAL of Line 9 Above - to Page 1; Sec. 005 621
TOTAL of Line 10 Above - to Page 1; Sec. 006 (or) 007 621

(
(

Product Pounds

0
0
0
0
0
0
0
0
0
0

Skim Pounds

0

0
0
0
0
0
0
0
0
0
0

Butterfat Pounds

0

0
0
0
0
0
0
0
0
0
0

0

I declare under the penalties provided by law, that this report (including any accompanying schedule and statements) has been examined by me and to the best of my knowledge and belief is a true, correct and complete report.
I also certify that I am authorized to sign this report.

Name of Handler _______________________________________________________

____________________________________________________________________
(PERSON AUTHORIZED TO SIGN FOR HANDLER)

Date __________________________________________________________________

(TITLE) ____________________________________________________________________

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 0581-0032. The time required to complete this information collection is estimated to average 1.5 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.
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.