Pima Cotton Agriculture Trust Fund

For Pima Agriculture Cotton Trust OMB No.: 0551-0044

Expiration Date:

Affidavit of Nationally Recognized Association to Claim Payment from the Pima Agriculture Cotton Trust Fund in 2021

Filed pursuant to section 12314 of the Agricultural Act of 2014

(P. L. 113-79)

The undersigned, _____(name)______, is _____(title), of the ______________(name of the association), and affirms that the_______________(name of the association), is a nationally recognized association established for the promotion of pima cotton grown in the United States for use in textile and apparel goods as such term described in section 12314 of the Agricultural Act of 2014. Attached is a description of the Association and supporting information to substantiate this affidavit.

I certify and affirm that to the best of my knowledge and belief all information contained in this claim and affidavit is complete and correct and no false claims, statements, or representations have been made.

_________________ _____________________________________

Date Signature

_____________________________________

Title

_____________________________________

Association Name

______________________________________

______________________________________

Address

( State of ____________________________

( County/City of _______________________

__________________________subscribed and sworn to before me this affidavit for a claim for payment from the Pima Agriculture Cotton Trust Fund this ____ day of __________, 2021.

Signature of Notary Public

__________________________________

My Commission expires _____________

E-Mail completed and notarized form to: [email protected]

Public reporting for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, and completing and reviewing the collection of information. All responses to this collection of information are voluntary, and will be provided confidentiality to the extent allowed under the Freedom of Information Act. Notwithstanding any other provision of the law, no person is required to respond to nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless the collection of information displays a current valid OMB control number. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Program Operations Division at: [email protected]