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. This valid OMB control number for this collection is
0581-0283. The time required to complete this information
collection is estimated to average 12 minutes per response,
including the time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, and
completing and reviewing the collection information.
TYPE
Faxed Certificate*
0
Additional Copies*
*additional charges apply
I acknowledge that by checking this box that the information
provided is factual and accurate.
CONTACT NAME
MAIL CERTIFICATE TO:
AMS
BILLING ACCT.
7. COMPANY
BILLING
REFERENCE
8. CONTACT
E-MAIL
ADDRESS
9. STREET
CONTACT
PHONE
10. CITY
FAX
11. STATE
12. ZIP
CONSIGNOR
14. NAME
15. ADDRESS
16. CITY/STATE
CONSIGNEE
17. NAME
18. ADDRESS
19. COUNTRY CODE
CL
IDENTIFICATION OF DAIRY
PRODUCTS
20. DESCRIPTION OF
COMMODITY
21. KIND OF HEAT
TREATMENT (HTST; PAST.)
22. TYPE OF PACKAGING
23. NUMBER OF PACKAGING
UNITS
24. NET WEIGHT
25. REQUIRED TEMPERATURE
DURING STORAGE AND TRANSPORTATION
27. EXPIRATION DATE
MANUFACTURER
28. PLANT NUMBER
;
;
SHIPMENT INFORMATION
30. ENTRY PORT
31. TRANSPORT TYPE
32. TRANSPORT NAME
33. CONTAINER NUMBER
34. SEAL NUMBER
SIGNATURE (for
faxed or mailed copies)
35. DATE
March 30, 2022
**For
fastest processing, please attach this form and a PDF shipping label
in an email to [email protected].
DA-244
(01/2013)
The
U.S. Department of Agriculture (USDA) prohibits discrimination in all
its programs and activities on the basis of race, color, national
origin, age, disability, and where applicable, sex, marital status,
familial status, parental status, religion, sexual orientation,
genetic information, political beliefs, reprisal, or because all or
part of an individual’s income is derived from any public
assistance program. (Not all prohibited bases apply to all
programs.) Persons with disabilities who require alternative means
for communication of program information (Braille, large print,
audiotape, etc.) should contact USDA’s TARGET Center at (202)
720-2600 (voice and TDD).
To
file a complaint of discrimination, write to USDA, Director, Office
of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C.
20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD).
USDA is an equal opportunity provider and employer.