Form TB-92 Tobacco Inspection Certificate

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SERIAL NUMBER

U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
COTTON AND TOBACCO PROGRAM

TOBACCO INSPECTION CERTIFICATE
Under the Tobacco Inspection Act of 1935

INSPECTED FOR THE ACCOUNT OF (Name and Srreet address or P.0. Box, City, State,

PACKAGE MARKS

CROP YEAR

and ZIP):

NUMBER OF PACKAGES IN LOT

TYPE NUMBER

OFFICIAL GRADE

REMARKS

DATE OF INSPECTION

TB-92 (Exp. X/XXXX) Destroy previous editions.

SIGNATURE OF OFFICIAL INSPECTOR

LOCATION OF INSPECTION (City and State);

COUNTRY OF ORIGIN

NET WEIGHT

TB-92 (Exp. X/XXXX)
TOBACCO INSPECTION CERTIFICATE

USDA’s Nondiscrimination Statement
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,
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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.

TB-92 (Exp. X/XXXX) Destroy previous editions