VS 1-24 Proceeds from Animals/Animal Products/Materials Sold for

OMB Approved
0579-0007, 0579-0065,
0579-0101, 0579-0146,
0579-0192, and XXXX

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 0579-0007, 0579-0065, 0579-0101 0579-0146, 0579-0192,
and XXXX. The time required to complete this information collection is estimated to average between .26 and 40 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.

PROCEEDS FROM
ANIMALS/ANIMAL PRODUCTS/MATERIALS
SOLD FOR SALVAGE

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES

No further monies or other benefits will be paid out under this program unless this report is completed and filed as required by existing regulations (9 CFR 49-199).
DESCRIPTION OF ANIMALS OR ANIMAL PRODUCTS OR MATERIALS
(Species, Type, ID)

PRICE
PER
UNIT

WEIGHT/UNIT

GROSS
RECEIPTS

EXPENSES 1/

NET SALVAGE
PAID TO OWNER/AGENT
OF EACH ANIMAL/ANIMAL
PRODUCTS/MATERIALS

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

TOTAL
SOLD TO (Name of Establishment)

CERTIFICATION
Purchaser

Seller

I certify that the sum(s) shown above which has been paid represents the net salvage from said animals/animal products/materials.
PAID TO (Owner or Agent)

DATE OF TRANSACTION

NAME OF PURCHASER OR SELLER

PREMISE ID NUMBER

DUNS NUMBER

By (Signature)

TITLE

DATE

1/ Show the total expenses of marketing, including charges for transportation, feeding, yardage, slaughter, and commission for selling agents, when applicable.

VS FORM 1-24
AUG 2018

Previous editions may be used.