Form PPQ 578 PPQ 578 Export Certificate

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control
number. The valid OMB control number for this information collection is 0579-0052 and 0207. The time required to complete this information collection is
estimated to average .03 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining 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

FORM APPROVED
OMB NO. 0579-0052
AND 0579-0207

FOR OFFICIAL USE ONLY

PLACE:
DATE:

EXPORT CERTIFICATE
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.