Form PPQ 540 PPQ 540 Certificate

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. The valid OMB
control numbers for this information collection are 0579-0088, 0322, 0331,
0337, and 0363. The time required to complete this information collection is
estimated to average between .16 and 2 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.

OMB
Approved
0579-0088,
0317, 0322,
0331, 0337,
and 0363

Information requested is needed to determine if a permit can be issued (7 CFR 301).

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
PLANT PROTECTION AND QUARANTINE

CERTIFICATE

E

This certificate must be surrendered to the
consignee at destination of shipment.

The articles described below are certified under all applicable Federal or
State cooperative domestic plant quarantines.

1. DATE ISSUED

2. VOID AFTER

3. NAME OF CONSIGNOR

4. SHIPPING POINT

5. NAME AND ADDRESS OF CONSIGNEE

6. VEHICLE LICENSE NUMBER AND STATE

7. R.R. CAR INITIALS AND NUMBER

8. DESCRIPTION
A. Quantity

B. Article

C. Remarks

9. SIGNATURE OF ISSUING INSPECTOR

PENALTY FOR MISUSE OR ALTERATION (7 U.S.C. 163)
PPQ FORM 540
FEB 2014

PART 1 - CONSIGNEE