PPQ 578 Export Certificate Processed Plant Products

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 0MB control number. The valid 0MB control numbers for these information collections ate 0579-0052 and 0579-0055.. The time
required to complete these information collections is estimated to average 20 minutes per response, including the time for reviewing instructions, searching
ex,stina data sources, aatherina and maintainina the data needed, and completing and reviewing the collection of information.

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

0MB APPROVED
0579-0052 AND 0579-0055
EXP DATE XY.JXXXX

FOR OFFICIAL USE ONLY

PLACE:

EXPORT CERTIFICATE

DATE:

PROCESSED PLANT PRODUCTS

NUMBER:

p

NAME AND ADDRESS OF EXPORTER

NAME AND ADDRESS OF CONSIGNEE

MEANS OF CONVEYANCE

POINT OF ENTRY

DESCRIPTION OF CONSIGNMENT
PRODUCT (Kind, Quantity, and Weight)

IDENTIFICATION

ORIGIN

WARNING: Any alteration, forgery, or unauthorized use of this certificate is subject to civil penalties of up to $250,000 (7 U.S.C. Section 7734(b)) or punishable by
a fine of not more than $10,000, or imprisonment of not more than 5 years, or both (18 U.S.C. Section 1001).

This is to affirm that, based upon inspection of submitted samples and/or by virtue of processing received, the plant products described above are
believed to be free from injurious plant pests.

NAME OF AUTHORIZED OFFICER

SIGNATURE

No liability shall attach to the United States Department of Agriculture or to any officer or representative of the Department with respect to this
certificate.
PPQ FORM 578

SEP 2001

Previous edition dated FEB 2001 may be used.