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Usda Lacey Act Declaration

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FORM APPROVED

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OMB No. 0579-0349

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Plant and Plant Product

U.S. DEPARTMENT OF AGRICULTURE

Declaration Form

ANIMAL AND PLANT HEALTH INSPECTION SERVICE

PLANT PROTECTION AND QUARANTINE

Section 3: Lacey Act Amendments of 2008 (16 U.S.C. 3372)

Applicability of Declaration:

You are required to complete this form if you are importing any of the following:

Any wild member of the plant kingdom, including roots, seeds, parts, or products thereof, and including

trees from either natural or planted forest stands, except:

1. Common cultivars, except trees, and common food crops (including roots, seeds, parts, or products thereof);

2. * Scientific specimens of plant genetic material (including roots, seeds, germplasm, parts, or products thereof)

that are to be used only for laboratory or field research;

3. * Plants that are to remain planted or to be planted or replanted; or

4. Plants used exclusively as packaging material to support, protect, or carry another item, unless the packaging

material itself is the item being imported.

* You must still complete this form if you are importing plants described under 3. and 4. that are listed:

· In an appendix to the Convention on International Trade in Endangered Species of Wild Fauna and Flora

(27 UST 1087; TIAS 8249);

· As an endangered or threatened species under the Endangered Species Act of 1973 (16 U.S.C. 1531 et seq.); or

· Pursuant to any State law that provides for the conservation of species that are indigenous to the State and are

threatened with extinction.

SECTION 1 - Shipment Information

1. ESTIMATED DATE OF ARRIVAL:

(MM/DD/YYYY)

2. ENTRY NUMBER:

3. CONTAINER NUMBER:

4. BILL OF LADING:

5. MID:

6. IMPORTER NAME:

8. CONSIGNEE NAME:

7. IMPORTER ADDRESS:

9. CONSIGNEE ADDRESS:

I certify under penalty of perjury that the information furnished is true and correct:

Signature

Type or Print Name

Date

Knowingly making a false statement in this Declaration for Importation may subject the declarant to criminal penalties in accordance with 16 U.S.C. 3373(d).

PPQ FORM 505

Version 12-08-2008-0856

Page 1

DECEMBER 2008

Usda Lacey Act Declaration

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