Form ITA-4139P Application for TRQ License, Average Fiber Diameter Grea

ITA-4139P

OMB No.: 0625-0240 Expires 11/30/2013

APPLICATION FOR 2014 TRQ LICENSE
MANUFACTURERS OF MEN’S & BOYS’ WORSTED WOOL SUITS,
SUIT-TYPE JACKETS AND TROUSERS
AVERAGE FIBER DIAMETER GREATER THAN 18.5 MICRONS
Data for January-June 2013

If data provided is to be treated as Business Confidential, please indicate prominently across top of form.

Company Name:
Company Address:

_______________________
_______________________

Company Federal Tax
Identification Number:

Contact Name:
Contact Address:

______________________
______________________

_______________________

______________________

_______________________

______________________

_______________________

Contact Telephone Number:
Contact Email Address:

________________
________________

Certification Statement: I, the duly authorized representative, as an employee, officer or agent, with personal knowledge of the matters set out in
the application, certify that the information contained herein is complete and accurate, signed and sworn before a Notary Public, and acknowledging
that false representations to a federal agency may result in criminal penalties under federal law.
Signature of Representative

Date

Signature of Notary

Date

Please check if garments are cut and sewn in your own plants.
and/or
Please check if garments were cut and sewn by a contractor and you had title to the fabric.
Note: Data based on microns.

M&B Worsted Wool Suits of
85% or More by Weight Wool

M&B Worsted Wool Suit-Type
Jackets of 85% or More by
Weight Wool

M&B Worsted Wool Trousers of
85% or More by Weight Wool

Greater than 18.5 Microns
Quantity and Value
Period

Units

($)

Units

January-June 2013

($)

January-June 2013

Units

($)

January-June 2013

Production (fob plant)
Using TRQ Fabric
Using Non-TRQ Fabric
Names and Addresses of Plants
Producing
Contractors and Locations of
Plants
For listing additional plants and/or contractors, go to the next page.
Public reporting for this collection of information is estimated to average 3 hours 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 Reports Clearance Officer, International
Trade Administration, Department of Commerce, Room 4001, 14 and Constitution Avenue, N.W., Washington, DC 20230.
th

Continued on Next Page

ITA-4139P

OMB No: 0625-0240 Expires 11/30/2013

Continuation Sheet APPLICATION FOR 2014 TRQ LICENSE

Purchases of
Quantity and Value
Period

Worsted Wool Fabric of 85% or
More by Weight Wool For
M&B Suits

Worsted Wool Fabric of 85% or
More by Weight Wool For M&B
Suit-Type Jackets

Worsted Wool Fabric of 85% or
More by Weight Wool For M&B
Trousers

Greater than 18.5 Microns

Greater than 18.5 Microns

Greater than 18.5 Microns

Square Meters

($)

Square Meters

January-June 2013

($)

January-June 2013

Square Meters

($)

January-June 2013

Domestic (fob plant)
Imports (value = c.i.f.)
TRQ Imports
Non-TRQ Imports

List Additional Plants Below

M&B Worsted Wool Suits of 85%
or More by Weight Wool

M&B Worsted Wool Suit-Type
Jackets of 85% or More by
Weight Wool

M&B Worsted Wool Trousers of
85% or More by Weight Wool

Greater than 18.5 Microns
Names and Addresses of Plants
Producing
Names and Addresses of Plants
Producing
Names and Addresses of Plants
Producing
List Additional Contractors Below

M&B Worsted Wool Suits of
85% or More by Weight Wool

M&B Worsted Wool Suit-Type
Jackets of 85% or More by
Weight Wool

M&B Worsted Wool Trousers of
85% or More by Weight Wool

Greater than 18.5 Microns
Contractors and Locations of
Plants
Contractors and Locations of
Plants
Contractors and Locations of
Plants
If additional space for listing plants and/or contractors is needed, use this page again after printing or attach a blank sheet of paper with the requested
information.
Mail completed, notarized form to: Office of Textiles and Apparel, Room 30003, U.S. Department of Commerce, 1401 Constitution Ave., NW,
Washington, DC 20230.