MA 201 Notification of Producer Change(s)

Return to: Federal Milk Order No. 1—Northeast Marketing Area
302A Washington Avenue Ext.
Albany, NY 12203-7303
Submitting Handler ___________________________________________________
Tel: (518) 452-4410 —Fax (518) 464-6468
Email: [email protected] Website: www.fmmone.com

Notification of Producer Change(s)

Please Check Type of Change:
New Producer
Address or Name Change

Instructions: On or before the 9th day after the end of the month, each handler shall
report to the Market Administrator all producer changes in farm operators.

Going Out of Business
Dairy Farmer for Other Market Re-association

MA
Number

Patron
Number

Check if
Organic

MA 201
Form Approved, OMB No. 0581-0032;
Exp. XX/XXXX

Name:

Producer

Mailing Address
(if mailing address is different from farm address please provide both)
Address:

Name:

Address:

Name:

Address:

Name:

Address:

Name:

Address:

Name:

Address:

Delivery
Start Date
Stop Date

Name of Handler/Cooperative Involved in
Change or Division Number

MA Office Use
___________________________________________________________________________________________________________________________________________
Person Authorized to Sign for Handler
Title

_____________________
Date

Initials ___________ Date ________________

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of information.
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